Abstract
BackgroundAlthough internal fixation has been the main treatment option for elderly patients with an undisplaced femoral neck fracture, it is associated with a high reoperation rate. Some surgeons have discussed the use of hemiarthroplasty, but there is limited literature comparing these two treatment modalities. In this study, we compared the perioperative results of hemiarthroplasty with internal fixation for undisplaced femoral neck fractures.MethodsWe performed a comprehensive review of literatures on PubMed, Web of Science, Embase, and the Cochrane Library for randomized controlled trials and comparative observational studies. Of the 441 studies initially identified, 3 met all inclusion criteria. Two reviewers independently graded study quality and abstracted relevant data including reoperation rate, mortality rate, Harris Hip Score (HHS), length of hospital stay, and operation duration.ResultsOur results revealed that hemiarthroplasty was associated with a lower reoperation rate than the internal fixation group (OR 4.489; 95% CI 2.030 to 9.927). Mortality rate at postoperative 1 month and 1 year and HHS at postoperative 1 year and 2 years were not different. Length of hospital stay (SMD − 0.800, 95% CI − 1.011 to − 0.589) and operation duration (SMD − 2.497, 95% CI − 2.801 to − 2.193) were shorter in the internal fixation group.ConclusionsCompared with the internal fixation group, patients that underwent hemiarthroplasty had a lower reoperation rate and an equivalent overall mortality rate. Our meta-analysis suggests that hemiarthroplasty might be a better treatment choice than internal fixation in treating elderly patients with an undisplaced femoral neck fracture.
Highlights
In current practice, internal fixation has been the treatment of choice for undisplaced femoral neck fractures
Inclusion criteria We considered studies that were eligible if they met the PICOS criteria: population—elderly patients (≥ 65 years old) with undisplaced femoral neck fracture; intervention—internal fixation or hemiarthroplasty as the surgical treatment method for undisplaced femoral neck fracture; comparator—internal fixation or hemiarthroplasty procedure; and outcomes—reoperation rate, 1-month and 1-year mortality rate, Harris Hip Score (HHS) at postoperative 1 year and 2 years, length of hospital stay, and operation duration
3 articles that compared internal fixation and hemiarthroplasty in undisplaced femoral neck fracture were included for our meta-analysis
Summary
Internal fixation has been the treatment of choice for undisplaced femoral neck fractures. The perioperative outcomes between hemiarthroplasty and internal fixation remain. Due to these inconclusive results, we conducted this meta-analysis to evaluate several outcome parameters. Ma et al Journal of Orthopaedic Surgery and Research (2019) 14:320 for elderly patients that underwent either hemiarthroplasty or internal fixation for undisplaced femoral neck fractures. Internal fixation has been the main treatment option for elderly patients with an undisplaced femoral neck fracture, it is associated with a high reoperation rate. We compared the perioperative results of hemiarthroplasty with internal fixation for undisplaced femoral neck fractures
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