Abstract
Displaced intracapsular femoral neck (AO type 31 B2/3) fractures have various treatments, including internal fixation (IF), unipolar uncemented hemiarthroplasty (HA), bipolar uncemented HA, unipolar cemented HA, bipolar cemented HA, uncemented total hip replacement (THR), and cemented THR. Systematic literature retrieval was performed from the databases to compare them in a network meta-analysis. Forty studies (85 arms) containing 6141 patients were included. Overall, our network meta-analysis rank the orders of 7 procedures in reoperation, mortality, dislocation and infection, which indicates that IF may provide the highest reoperation incidence, unipolar cemented HA may provide the lowest reoperation incidence; uncemented THR contributes the highest dislocation incidence; and bipolar uncemented HA provides the lowest infection incidence. No differences in mortality were observed among the treatments. This conclusion is indirect; higher-quality direct comparisons are required.
Highlights
Femoral neck fractures are among the most common orthopedic injuries in the elderly
The results showed that the reoperation incidence was higher in the internal fixation (IF) group than in the other groups
The results showed that the infection incidence in IF group was lower than that in the unipolar uncemented HA group (OR = 0.49; 95% credibility intervals (CrIs) 0.20 to 0.99)
Summary
Femoral neck fractures are among the most common orthopedic injuries in the elderly. In 1990, the estimated number of femoral neck fractures was 1.66 million worldwide, per year. Treatments for displaced intracapsular femoral neck fracture have included closed or open reduction and internal fixation (IF), hemiarthroplasty (HA), and total hip replacement (THR). In contrast, bipolar HA resulted in better health-related quality of life beyond the first 2 years following surgery, compared to unipolar HA, in a study performed by Inngul et al.. When considering uncemented or cemented THR, no direct evidence exists to evaluate relative performances. RCTs comparing uncemented and cemented THR have focused on whether either of these treatments provide better outcomes than IF in hip function. To comprehensively evaluate the efficacy and complications of the 7 surgical procedures, we performed a Bayesian network meta-analysis via a global search of published RCTs on this topic, providing evidence for clinical decision-making
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