Comparison of hemiarthroplasty and internal fixation in the treatment of nondisplaced femo-ral neck fractures:a meta-analysis
Ran Tangfei
Liu Jinlian
Wang Zhen
Chen Bo
Guo Shiwu
Abstract：Objective To compare the clinical effect of hemiarthroplasty(HA)and internal fixation(IF)in the treatment of nondisplaced femoral neck fractures in the elderly.Method The databases of Pubmed,Co-chrane Library,Embase,Medline,Wanfang,VIP,CNKI were retrieved from their establishment to Oct.2023 for ran-domized controlled trials and cohort studies on HA and IF in managing nondisplaced femoral neck fractures.A total of 1374 documents were obtained.Two orthopedic physicians independently finished the screening,quality evalua-tion,and data extracting of the literature.Data analysis was achieved by using RevMan5.4 software.Results Me-ta-analysis showed that compared with HA group,the IF group had a much higher re-operation rate(RR=2.55,95%CI:1.90 to 3.44,df=10,P<0.001)and postoperative total complication rate(RR=2.33,95%CI:1.71 to 3.18,df=8,P<0.001),but much lower postoperative 1-month mortality rate(RR=0.74,95%CI:0.58 to 0.93,df=3,P=0.010)and 1-year mortality rate(RR=0.80,95%CI:0.71 to 0.91,df=5,P<0.001).However,the follow-up mor-tality rate revealed no statistically significant difference between the two groups(RR=1.05,95%CI:0.83-1.32,df=5,P=0.700).Moreover,the IF group showed much less surgical time(SMD=-2.43,95%CI:-2.88 to-1.99,df=6,P<0.001),surgical blood loss(MD=-141.61 mL,95%CI:-182.30 to-100.92,df=5,P<0.001),blood transfusion rate(RR=0.12,95%CI:0.05 to 0.33,df=2,P<0.001),and length of hospital stay(MD=-2.68 d,95%CI:-3.70 to-1.67,df=5,P<0.001),but significantly lower Harris score at 3 months postoperatively(MD=-9.44,95%CI:-12.21 to-6.67,df=1,P<0.001).The Harris score revealed no statistically significant difference at 1 year af-ter surgery(MD=-2.01,95%CI:-4.28 to 0.26,df=3,P=0.080)and last follow-u(MD=-0.34,95%CI:-1.42 to 0.73,df=5,P=0.530).The last follow-up EQ-5D score was much lower in the IF group than in the HA group(MD=-0.07,95%CI:-0.13 to-0.02,df=2,P=0.010).Conclusion For nondisplaced femoral neck fractures,HA and IF exhibit different characteristics.The overall complication rate and reoperation rate after HA are lower,but the patient mortality rate is higher within one year.Compared with IF,patients who undergo HA have longer sur-gical and hospitalization time,more surgical bleeding,and higher blood transfusion rates.Three months after surger-y,patients who underwent HA exhibited superior hip function and quality of life compared to those who underwent IF.However,there were no significant differences in long-term hip function between the two groups.
Keywords：Nondisplaced femoral neck fracturesFixationinternalArthroplastyElderlyClinical control
Publication Date：2025-01-14
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：10( 50-59 )