One-stage total hip arthroplastyversusfemoral head arthroplasty for elderly femoral neck fractures：a meta-analysis of hip function and complications

Ye Xiang-yang; Wang Hua-lei; Zhao Yu-guo; Wang Hai-yu; Cheng Sheng

doi:10.3969/j.issn.2095-4344.2016.22.019

Abstract：BACKGROUND:There are objections to the efficacy and safety of total hip arthroplasty and artificial femoral head arthroplasty in the treatment of femoral neck fracture. <br> OBJECTIVE:To assess the efficacy and safety of one-stage total hip arthroplasty and femoral head arthroplasty for > 60-year-old patients with femoral neck fractures. <br> METHODS:According to the search strategy of Cochrane colaboration network, we searched PubMed (1966 to December 2014), EMbase (1974 to December 2014), Cochrane Library (Issue 3, 2011), China Biology Medicine database(1978 to December 2014), China National Knowledge Infrastructure (1994 to December 2014), VIP database (1989 to December 2014), and Wanfang Database (1979 to December 2014). Twenty-one articles on total hip arthroplasty and hemiarthroplasty for elderly femoral neck fractures were included. Two reviewers independently evaluated the quality of the included studies and extracted the data. In case of disagreement, settlement was made by negotiation. Meta-analysis was performed by RevMan 5.0 software in the included studies. <br> RESULTS AND CONCLUSION:(1) Literature analysis: five randomized controled studies, three quasi-randomized controled studies, and thirteen retrospective cohort studies were included, containing 2 250 patients. (2) Meta-analysis: No significant differencein rate of dislocation, deep infection rate and mortality rate in 1 year after replacement was detected between total hip arthroplasty and hemiarthroplasty for elderly femoral neck fractures (dislocation rate:RR=1.38, 95%CI: 0.81-2.34; deep infection rate RR=1.12, 95%CI: 0.60-2.11; mortality rateRR=0.90, 95%CI: 0.69-1.18). Reoperation rate was higher in the hemiarthroplasty group than in the total hip arthroplasty group (RR=0.46, 95%CI: 0.32-0.66). Harris score on the affected side between1 and 4 years was significantly higher in the total hip arthroplasty group than in the hemiarthroplasty group (MD=5.64, 95%CI: 2.82-8.46). (3) Results suggested that if physical conditions permit, compared with hemiarthroplasty group, femoral neck fractures patients aged > 60 years old in the total hip arthroplasty group had better hip function, but no significant difference was found in dislocation, deep infection and mortality between both groups.