A meta-analysis of the clinical outcomes of hip arthroplasty and internal ifxation for displaced femoral neck fractures in the elderly

LIU Bing-gen; PANG Qing-jiang

doi:10.3969/j.issn.2095-252X.2015.04.008

Abstract：Objective To analyze the domestic and foreign literatures on hip arthroplasty and internal fixation for displaced femoral neck fractures in the elderly and to evaluate the clinical outcomes and safety. Methods Cochrane central register of controlled trials ( Issue 1, 2014 ) and MEDLINE, EMbase, PubMED and China National Knowledge Infrastructure ( CNKI ) from January 1969 to December 2013 were searched by the computer. Only randomized controlled trials ( RCT ) in which hip arthroplasty and internal ifxation were compared in the treatment of femoral neck fractures in the elderly ( >60 years old ) were included. The literatures meeting the inclusion criteria were screened, and then were strictly evaluated. A meta-analysis of the research results was performed by the RevMan5.0 software from the Cochrane collaboration, and additionally the heterogeneity of data was checked.Results There were 124 potentially relevant papers, and 24 RCT were included at last. A total of 4859 cases were included, with 2619 cases in the hip arthroplasty group and 2240 cases in the internal ifxation group. The meta-analysis results showed both the reoperation rate and the complication rate were obviously lower in the hip arthroplasty group than that in the internal ifxation group [OR=0.13, 95%CI ( 0.09, 0.18 ),P<0.00001 ] [OR=0.15, 95%CI ( 0.10, 0.22 ),P<0.00001 ], and the differences between them were statistically signiifcant. No statistically signiifcant differences were noticed in the case fatality rate in the follow-up of 2 years, 10 years and more than 10 years.Conclusions The postoperative rate of reoperation and the complication rate can be obviously reduced in the elderly patients with displaced femoral neck fractures undergoing hip arthroplasty, but the case fatality rate cannot be reduced. Therefore, hip arthroplasty is the best choice in the treatment of displaced femoral neck fractures in the elderly.