Background Although 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. Methods We 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. Results Our 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. Conclusions Compared 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.

Background Periarticular injection (PAI) is a regional analgesia method performed in total hip arthroplasty (THA) for postoperative pain relief. However, its efficacy and safety is still inconclusive. Therefore, we conducted this meta-analysis to assess the safety of PAI and to determine if PAI provides better pain relief and reduce the consumption of opioids after THA. Methods We searched PubMed, Web of Science, Embase and the Cochrane Library comprehensively. Only randomized control trials were included in our meta-analysis. Eleven studies that compared the efficacy of PAI with the control group were included. The preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines and Jadad score were applied to assess the quality of the included studies. We used the recommendations by the Cochrane Collaboration to reduce bias and to ensure our results were reliable and veritable. Results Our analysis demonstrated that PAI was more effective than the control group with a lower visual analog scale (VAS) score during rest at 24 h ( P = 0.003), 48 h ( P = 0.002), and VAS score with activity at 24 h ( P = 0.04). There was also less amount of opioid consumption ( P = 0.01). There were no differences in length of hospital stay ( P = 0.526) and postoperative nausea rate ( P = 0.153). Conclusion Compared with the control group, PAI showed better pain relief and less amount of opioid consumption after THA. Our meta-analysis suggests that PAI is a safe and effective multimodal analgesia technique that can be used for THA. Electronic supplementary material The online version of this article (10.1186/s12891-019-2628-7) contains supplementary material, which is available to authorized users.

Background Continuous popliteal sciatic nerve block (CPSNB) has been performed in outpatient foot and ankle surgery as a regional anesthesia method to relieve postoperative pain. Its efficacy as well as safety is yet to be established. There are two purposes of this study: (1) to validate the efficacy of CPSNB with regards to better pain relief and reduced analgesics consumption; (2) to assess the safety of CPSNB. Methods We performed a comprehensive literature review on Web of Science, the Cochrane Library, PubMed and Embase and only included randomized controlled trials (RCTs). Five RCTs that compared the efficacy and safety of CPSNB with the single-injection popliteal sciatic nerve block group were included. The primary outcome parameters were visual analog scale (VAS) scores at postoperative 24, 48 and 72 h. The secondary outcome parameters were amount of oral analgesics consumed, overall patient satisfaction and need of admission after surgery. A sensitivity analysis was performed to explore the consistency of the results. Results In comparison with the single-injection group, CPSNB was associated with a lower VAS score at postoperative 24 and 48 h (p < 0.05). There were no neuropathic symptoms or infection events after the nerve block. However, there were several minor complications associated with the pump and catheter system, with drug leakage being the most common complication (N = 26 of 187, 13.9%). Conclusion CPSNB is an effective method in pain management for outpatient foot and ankle surgery. Both methods appear to be safe as none of the patients experienced neuropathic symptoms or infection. Further studies with larger sample size are needed to compare the risk of major complications between the two methods. Level of evidence I; meta-analysis.

Background Several cup anteversion measurements for post-operative total hip arthroplasty (THA) surgery have been described. We developed the standardized Liaw’s trigonometric method to eliminate the influence of patient position, which is the most accurate method for cup anteversion measurement. We then developed an ellipse method using the Elliversion software and reported an interobserver error reduction in 2013. In this study, we attempted to apply this ellipse method in the clinic and compared its accuracy with the standard trigonometric version. Methods In the present study, we attempted to incorporate the ellipse method with Liaw’s standardized anteversion in the simulated cup position. We measured standardized Liaw’s anteversion for 434 radiographs in the clinic using the ellipse method. Repeated standard deviation (RSD) was calculated for accuracy evaluation. Furthermore, paired t-test was used for comparison with the interobserver and intraobserver errors. Results We found that the standardized Liaw’s anteversion measured using the ellipse method showed lower RSD than the radiographic version. RSD was 0.795 in the standardized Liaw’s anteversion with ellipse method group. The p-values of the paired t-test were all higher than 0.05 when measuring the interobserver and intraobserver errors. It indicated that the ellipse method was a precise and simple tool for cup anteversion measurement. Conclusion We believe that this ellipse measurement can assist surgeons while placing the acetabulum cup into the precise position and enable early diagnosis of acetabulum loosening.