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Archives of Orthopaedic and Trauma Surgery

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13.03.2020 | Trauma Surgery

Hemiarthroplasty versus total arthroplasty for displaced femoral neck fractures in the elderly: meta-analysis of randomized clinical trials

verfasst von: Filippo Migliorini, Andromahi Trivellas, Arne Driessen, Valentin Quack, Yasser El Mansy, Hanno Schenker, Markus Tingart, Jörg Eschweiler

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 11/2020

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Abstract

Introduction

Displaced femoral neck fractures (FNF) are complicated by high mortality rates and continue to represent an important cause of disability, having a negative impact on patient mobility and physical independence. The purpose of this study was to update and analyse current outcomes and evidence concerning hip hemiarthroplasty (HHA) versus total hip arthroplasty (THA) for displaced femoral neck fractures in the elderly. Thus, a meta-analysis of randomized clinical trials was conducted.

Materials and methods

This meta-analysis was conducted according to the PRISMA guidelines. In October 2019, the following databases were accessed: Embase, Google Scholar, Pubmed, Scopus. All randomized clinical trials (RCTs) comparing total hip arthroplasty versus hip hemiarthroplasty for displaced femoral neck fractures were included in the present study. For the statistical analysis and the methodological quality assessment, the Review Manager Software 5.3 (The Nordic Cochrane Collaboration, Copenhagen) and STATA/MP Software 14.1 (StataCorp, College Station, TX) were used.

Results

Data from 2325 (1171 HHA vs 1154 THA) patients were collected. The mean follow-up was 58.12 months. The HHA group reported lower values of the mean Harris hip score (EE 3.22; p = 0.2), surgical duration (EE 21.75; p < 0.0001), length of the hospitalization stay (EE 0.8; p = 0.4). The HHA group evidenced lower dislocations rate (OR 1.78; p = 0.01, Fig. 4), but higher rate of acetabular erosion (OR 0.08; p = 0.0006). At a mean of 58.12 ± 52.8 months follow-up, revisions rate scored reduced in the THA group (OR 0.76; p = 0.2). Subgroup analysis of RCTs < 5 years follow-up revealed reduced revision in favour of the HHA group (OR 2.19; p = 0.03), while subgroup analysis of RCTs > 5 years follow-up revealed reduced revision in favour of the THA group (OR 0.25; p = 0.0003). The Kaplan–Meier curve detected similarity of patients survivorship between the two groups (HR 1.06; p = 0.3).

Conclusion

For the elderly population, both HHA and THA are valid solutions to treat displaced femoral neck fractures, with comparable survivorship. HHA detected reduced dislocations, while for THA a lower risk of acetabular erosion and further revision surgeries were reported.

Level of evidence

Level I, meta-analysis of randomized clinical trials.

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Titel: Hemiarthroplasty versus total arthroplasty for displaced femoral neck fractures in the elderly: meta-analysis of randomized clinical trials
verfasst von: Filippo Migliorini
Andromahi Trivellas
Arne Driessen
Valentin Quack
Yasser El Mansy
Hanno Schenker
Markus Tingart
Jörg Eschweiler
Publikationsdatum: 13.03.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Orthopaedic and Trauma Surgery / Ausgabe 11/2020
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-020-03409-3

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