Does Arthroplasty Provide Better Outcomes Than Internal Fixation At Mid- and Long-term Followup? A Meta-analysis

Abstract

Background Arthroplasty has been shown to be superior regarding low risk of reoperation and better function score to internal fixation for treatment of displaced femoral neck fractures at short-term followup. However, there are unanswered questions regarding the efficacy of arthroplasty in the longer term compared with internal fixation. Questions/purposes We performed a meta-analysis comparing arthroplasty (hemiarthroplasty or THA) with internal fixation in patients with displaced femoral neck fractures with respect to (1) mortality, (2) reoperation, (3) functional recovery, and (4) complications, including only randomized trials with a minimum of 4 years followup.Methods Computerized databases, including PubMed (MEDLINE), EMBASE, Cochrane Register of Controlled Trials databases, and Web of Science TM were searched for studies published from the inception date for each database to March 2014. Eleven randomized controlled trials that compared arthroplasty (either hemiarthroplasty or THA) with internal fixation for treatment of patients with a femoral neck fracture were included in our analysis. The quality of the trials was assessed according to the Cochrane Handbook and meta-analyses were conducted using RevMan 5.2 software from the Cochrane Collaboration. The heterogeneity among studies was evaluated by the I-squared index (I 2 ) and publication bias was assessed using forest plots. Results There were no differences between the internal fixation and arthroplasty groups for patient mortality at midterm (48.4% vs 46.8%) or long-term followup (83.2% vs 81.5%). Arthroplasty was associated with a lower risk of reoperation at mid-term (7.2% vs 39.8%; relative risk [RR] = 0.10; 95% CI, 0.06-0.07) and at long-term followup (14.3% vs 43.8%; RR = 0.10; 95% CI, 0.06-0.07). Arthroplasty was associated with better functional recovery at mid-term followup (standard mean difference [SMD] = 0.55; 95% CI, 0.02-1.09), whereas function at long-term followup (SMD = 0.14; 95% CI, À0.35 to 0.62) was not different between the arthroplasty and internal fixation groups. There were no significant differences in subsequent ipsilateral fractures (1.5% vs 1.2%; RR = 2.18; 95% CI, 0.32-14.67; p = 0.42) and deep infections (2.7% vs 2.9%; RR = 0.89; 95% CI, 0.40-2.01; p = 0.78) between patients treated with arthroplasty and internal fixation. Conclusions Based on our results, we found that compared with internal fixation, arthroplasty may result in a lower rate of subsequent reoperation at mid-and long-term followup, and better mid-term functional recovery. Future

Improved outcome after hip fracture surgery in Norway

“… 2012 , Jiang et al. 2015 ). The superiority of HA over IF for the displaced FFNs was shown in a Norwegian randomized controlled study in 2007 (Frihagen et al.…”

EULAR/EFORT recommendations for management of patients older than 50 years with a fragility fracture and prevention of subsequent fractures

“…In frail patients, hemiarthroplasty might be preferred, since operative time is shorter and the subsequent dislocation risk is lower while the functional outcome is acceptable 42. Total hip arthroplasty may offer improved function and long-term results,43 but patient factors and surgeon experience need to be considered in order to justify the risk of a more complex and costly procedure 13…”

Total Hip Arthroplasty for Bilateral Femoral Neck Stress Fracture: A Case Report and Review of the Literature

“…e incidence of infection and dislocation following THA for femoral neck fractures are probably the same as those in the general population, but we do not have the data to back this assumption. However, salvage THA after failed internal fixation of the neck fracture is associated with higher complication rates [30][31][32].…”