Abstract
BackgroundWe performed an updated systematic review and meta-analysis which enrolled 25 prospective randomized controlled trials (RCTs) to compare the outcomes between total hip arthroplasty (THA) and hemiarthroplasty (HA) in patients with femoral neck fractures (FNFs).MethodsWe searched English databases which included PubMed, Embase (vis OvidSP), The Cochrane Library, and Web of Science, and Chinese databases Chinese National Knowledge Infrastructure (CNKI), VIP, Wang Fang, and China Biology Medicine Disc (CBM) in July 2020. The quality of each study was assessed according to the Cochrane Collaboration’s Risk of Bias. Risk ratios (RRs) and weighted mean differences (WMDs) with 95% confidence intervals (95% CIs) were pooled with random-effects models. Data regarding baseline characteristics, hospital and surgery outcomes, clinical outcomes, patients’ quality of life, common complications, prothesis-related complications, mortality, and costs were reported.ResultsA total of 25 RCTs involving 3223 patients (1568 THA and 1655 HA) were included. THA had longer hospital length (WMD = 0.721, P < 0.0001) and surgery time (WMD = 20.044, P < 0.0001), and more blood loss compared with HA (WMD = 69.109, P < 0.0001). THA showed better ratings in the Harris Hip Score during follow-up periods between 1 and 5 years while no differences within 6 months and after 9 years. THA was associated with higher quality-of-life EuroQol-5 Dimension (EQ-5D) scores after 2 years of surgery but no difference within 1 year. There was no difference in common complications. THA had significant higher rate of dislocation (WMD = 1.897, P = 0.002) and lower acetabular erosion (WMD = 0.030, P = 0.001). For mortality, there was no difference during all the follow-up periods except for slightly higher 2-year mortality after surgery.ConclusionThis meta-analysis demonstrates that THA has better medium-term functional results and quality of life and lower acetabular erosion rate, while HA shows better in reducing hospital stay, surgery time, and blood loss and also has lower dislocation rate.
Highlights
We performed an updated systematic review and meta-analysis which enrolled 25 prospective randomized controlled trials (RCTs) to compare the outcomes between total hip arthroplasty (THA) and hemiarthroplasty (HA) in patients with femoral neck fractures (FNFs)
Searches and selection criteria We searched English databases which included PubMed, Medline, Embase, The Cochrane Library, and Web of Science and Chinese databases Chinese National Knowledge Infrastructure (CNKI), VIP, WAN FANG, and China Biology Medicine Disc (CBM) without language or date restriction as well as retrieving articles identified in other reviews by manual search
Patients’ quality of life The results showed that EuroQol Five Dimensions Questionnaire (EQ-5D) scores within 6 months (WMD = 0.031, P = 0.324) and at the first year after surgery (WMD = 0.033, P = 0.351)
Summary
We performed an updated systematic review and meta-analysis which enrolled 25 prospective randomized controlled trials (RCTs) to compare the outcomes between total hip arthroplasty (THA) and hemiarthroplasty (HA) in patients with femoral neck fractures (FNFs). Whether THA or HA is more applicable in FNF remains controversial [21] Both pros and cons of the treatments were widely reported in previous studies and synthesized reviews but did not reach a common conclusion [6, 11, 13, 15, 17, 24, 26, 33, 49– 52]. Previous meta-analysis and reviews have several limitations They did not fully mention the details of surgical approach, prosthetic choice, surgeon experience, and the type of both femoral and acetabular fixation, all of which we consider may cause chaos in conclusion. Randomized controlled trials (RCTs) with high quality have been published recently and not been included, and we carefully selected Chinese articles reported with enough follow-up duration and reported outcomes in our analysis [3, 8, 18, 25, 27, 31, 38, 44]
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