Hip arthroplasty versus internal fixation for treatment of femoral neck fractures in the elderly in China: a meta-analysis

Abstract

Objective To compare the clinical effects of internal fixation (IF) versus hip arthroplasty (HA) for the treatment of femoral neck fractures in the elderly (≥60 years of age) in China.Methods We electronically searched for all clinical trials in China comparing IF versus HA for the treatment of displaced femoral neck fractures in the elderly (≥60 years of age) in PubMed (2000 to 2012),OVID MEDLINE (2000 to 2012),SinoMed (2000 to 2012),Wanfang data (2000 to 2012),and China Knowledge Resource Integrated Database (2000 to 2012).A meta-analysis was conducted to assess postoperative one-year mortality,general complications,major complications,reoperation,and functional recovery between IF and HA.Quality of the trials was assessed.The meta-analysis was conducted using Stata 10.0 software.Results Altogether 24 eligible trials (4 randomized controlled trials and 20 observational studies) involving a total of 2738 patients were included in the present meta-analysis.The results showed no significant difference in postoperative one-year mortality [OR =0.97,95％ CI(0.44,2.11),P =0.929] between IF and HA.Patients undergoing HA had significantly lower rates of general complications [OR =0.48,95％ CI(0.31,0.74),P =0.001],major complications [OR =0.35,95％ CI(0.27,0.44),P ＜ 0.001] and reoperation [OR =0.24,95％ CI(0.18,0.33),P ＜ 0.001],but significantly better functional recovery of the hip joint than patients undergoing IF [OR=2.15,95％ CI (1.73,2.67),P ＜0.001].Conclusion HAmaybea better treatment than IF for elderly Chinese patients with displaced femoral neck fracture. Key words: Femoral neck fractures; Arthroplasty, replacement, hip; Fracture fixation, internal; Meta-analysis