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Archives of Orthopaedic and Trauma Surgery

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01-11-2020 | Hip-TEP | Trauma Surgery

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

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

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 11/2020

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.

Zuckerman JD (1996) Hip fracture. N Engl J Med 334(23):1519–1525. https://doi.org/10.1056/NEJM199606063342307CrossRefPubMed

Thorngren KG, Hommel A, Norrman PO, Thorngren J, Wingstrand H (2002) Epidemiology of femoral neck fractures. Injury 33(Suppl 3):C1–7CrossRef

Benetos IS, Babis GC, Zoubos AB, Benetou V, Soucacos PN (2007) Factors affecting the risk of hip fractures. Injury 38(7):735–744. https://doi.org/10.1016/j.injury.2007.01.001CrossRefPubMed

De Laet CE, Pols HA (2000) Fractures in the elderly: epidemiology and demography. Baillieres Best Pract Res Clin Endocrinol Metab 14(2):171–179. https://doi.org/10.1053/beem.2000.0067CrossRefPubMed

Miyamoto RG, Kaplan KM, Levine BR, Egol KA, Zuckerman JD (2008) Surgical management of hip fractures: an evidence-based review of the literature. I: femoral neck fractures. J Am Acad Orthop Surg 16(10):596–607CrossRef

Harvey N, Dennison E, Cooper C (2010) Osteoporosis: impact on health and economics. Nat Rev Rheumatol 6(2):99–105. https://doi.org/10.1038/nrrheum.2009.260CrossRefPubMed

Parker MJ, Gurusamy K (2006) Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD001706.pub3CrossRefPubMedPubMedCentral

Bhandari M, Devereaux PJ, Tornetta P 3rd, Swiontkowski MF, Berry DJ, Haidukewych G, Schemitsch EH, Hanson BP, Koval K, Dirschl D, Leece P, Keel M, Petrisor B, Heetveld M, Guyatt GH (2005) Operative management of displaced femoral neck fractures in elderly patients. An international survey. J Bone Jt Surg Am 87(9):2122–2130. https://doi.org/10.2106/JBJS.E.00535CrossRef

Burgers PT, Van Geene AR, Van den Bekerom MP, Van Lieshout EM, Blom B, Aleem IS, Bhandari M, Poolman RW (2012) Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures in the healthy elderly: a meta-analysis and systematic review of randomized trials. Int Orthop 36(8):1549–1560. https://doi.org/10.1007/s00264-012-1569-7CrossRefPubMedPubMedCentral

10.

Iorio R, Schwartz B, Macaulay W, Teeney SM, Healy WL, York S (2006) Surgical treatment of displaced femoral neck fractures in the elderly: a survey of the American Association of Hip and Knee Surgeons. J Arthroplasty 21(8):1124–1133. https://doi.org/10.1016/j.arth.2005.12.008CrossRefPubMed

11.

Alolabi N, Alolabi B, Mundi R, Karanicolas PJ, Adachi JD, Bhandari M (2011) Surgical preferences of patients at risk of hip fractures: hemiarthroplasty versus total hip arthroplasty. BMC Musculoskelet Disord 12:289. https://doi.org/10.1186/1471-2474-12-289CrossRefPubMedPubMedCentral

12.

Macaulay W, Pagnotto MR, Iorio R, Mont MA, Saleh KJ (2006) Displaced femoral neck fractures in the elderly: hemiarthroplasty versus total hip arthroplasty. J Am Acad Orthop Surg 14(5):287–293. https://doi.org/10.5435/00124635-200605000-00004CrossRefPubMed

13.

Macaulay W, Yoon RS, Parsley B, Nellans KW, Teeny SM, Consortium D (2007) Displaced femoral neck fractures: is there a standard of care? Orthopedics 30(9):748–749CrossRef

14.

Rodriguez-Merchan EC (2002) Displaced intracapsular hip fractures: hemiarthroplasty or total arthroplasty? Clin Orthop Relat Res 399:72–77CrossRef

15.

Schmidt AH, Leighton R, Parvizi J, Sems A, Berry DJ (2009) Optimal arthroplasty for femoral neck fractures: is total hip arthroplasty the answer? J Orthop Trauma 23(6):428–433. https://doi.org/10.1097/BOT.0b013e3181761490CrossRefPubMed

16.

Yu L, Wang Y, Chen J (2012) Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures: meta-analysis of randomized trials. Clin Orthop Relat Res 470(8):2235–2243. https://doi.org/10.1007/s11999-012-2293-8CrossRefPubMedPubMedCentral

17.

Zi-Sheng A, You-Shui G, Zhi-Zhen J, Ting Y, Chang-Qing Z (2012) Hemiarthroplasty vs primary total hip arthroplasty for displaced fractures of the femoral neck in the elderly: a meta-analysis. J Arthroplasty 27(4):583–590. https://doi.org/10.1016/j.arth.2011.07.009CrossRefPubMed

18.

Wang F, Zhang H, Zhang Z, Ma C, Feng X (2015) Comparison of bipolar hemiarthroplasty and total hip arthroplasty for displaced femoral neck fractures in the healthy elderly: a meta-analysis. BMC Musculoskelet Disord 16:229. https://doi.org/10.1186/s12891-015-0696-xCrossRefPubMedPubMedCentral

19.

Cadossi M, Chiarello E, Savarino L, Tedesco G, Baldini N, Faldini C, Giannini S (2013) A comparison of hemiarthroplasty with a novel polycarbonate-urethane acetabular component for displaced intracapsular fractures of the femoral neck: a randomised controlled trial in elderly patients. Bone Jt J 95-B(5):609–615. https://doi.org/10.1302/0301-620X.95B5.31083CrossRef

20.

Rasi AMKS, Moghadam MET, Kazemian GH, Ebrahiminia MR (2014) Comparison of total hip arthroplasty (THA) and hemiarthroplasty (HA) in femoral neck fractures of elderly patients. Nova J Med Biol Sci 3(3):1–4CrossRef

21.

Tol MC, van den Bekerom MP, Sierevelt IN, Hilverdink EF, Raaymakers EL, Goslings JC (2017) Hemiarthroplasty or total hip arthroplasty for the treatment of a displaced intracapsular fracture in active elderly patients: 12-year follow-up of randomised trial. Bone Jt J 99-B(2):250–254. https://doi.org/10.1302/0301-620X.99B2.BJJ-2016-0479.R1CrossRef

22.

Investigators H, Bhandari M, Einhorn TA, Guyatt G, Schemitsch EH, Zura RD, Sprague S, Frihagen F, Guerra-Farfan E, Kleinlugtenbelt YV, Poolman RW, Rangan A, Bzovsky S, Heels-Ansdell D, Thabane L, Walter SD, Devereaux PJ (2019) Total hip arthroplasty or hemiarthroplasty for hip fracture. N Engl J Med 381(23):2199–2208. https://doi.org/10.1056/NEJMoa1906190CrossRef

23.

Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535. https://doi.org/10.1136/bmj.b2535CrossRef

24.

Howick J CI, Glasziou P, Greenhalgh T, Heneghan C, Liberati A, Moschetti I, Phillips B, Thornton H, Goddard O, Hodgkinson M (2011) The 2011 Oxford levels of evidence. Oxford Centre for Evidence-Based Medicine.https://www.cebm.net/indexaspx?o=5653. Accessed Oct 2019

25.

Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Jt Surg Am 51(4):737–755CrossRef

26.

Avery PP, Baker RP, Walton MJ, Rooker JC, Squires B, Gargan MF, Bannister GC (2011) Total hip replacement and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck: a seven- to ten-year follow-up report of a prospective randomised controlled trial. J Bone Jt Surg Br 93(8):1045–1048. https://doi.org/10.1302/0301-620X.93B8.27132CrossRef

27.

Blomfeldt R, Tornkvist H, Eriksson K, Soderqvist A, Ponzer S, Tidermark J (2007) A randomised controlled trial comparing bipolar hemiarthroplasty with total hip replacement for displaced intracapsular fractures of the femoral neck in elderly patients. J Bone Jt Surg Br 89(2):160–165. https://doi.org/10.1302/0301-620X.89B2.18576CrossRef

28.

Hedbeck CJ, Enocson A, Lapidus G, Blomfeldt R, Tornkvist H, Ponzer S, Tidermark J (2011) Comparison of bipolar hemiarthroplasty with total hip arthroplasty for displaced femoral neck fractures: a concise four-year follow-up of a randomized trial. J Bone Jt Surg Am 93(5):445–450. https://doi.org/10.2106/JBJS.J.00474CrossRef

29.

Keating JF, Grant A, Masson M, Scott NW, Forbes JF (2006) Randomized comparison of reduction and fixation, bipolar hemiarthroplasty, and total hip arthroplasty. Treatment of displaced intracapsular hip fractures in healthy older patients. J Bone Jt Surg Am 88(2):249–260. https://doi.org/10.2106/JBJS.E.00215CrossRef

30.

Mouzopoulos G, Stamatakos M, Arabatzi H, Vasiliadis G, Batanis G, Tsembeli A, Tzurbakis M, Safioleas M (2008) The four-year functional result after a displaced subcapital hip fracture treated with three different surgical options. Int Orthop 32(3):367–373. https://doi.org/10.1007/s00264-007-0321-1CrossRefPubMed

31.

Ravikumar KJ, Marsh G (2000) Internal fixation versus hemiarthroplasty versus total hip arthroplasty for displaced subcapital fractures of femur—13 year results of a prospective randomised study. Injury 31(10):793–797CrossRef

32.

Woon CYL, Moretti VM, Schwartz BE, Goldberg BA (2017) Total hip arthroplasty and hemiarthroplasty: US national trends in the treatment of femoral neck fractures. Am J Orthop (Belle Mead NJ) 46(6):E474–E478

33.

Grosso MG, Danoff JR, Padgett DE, Iorio R, Macaulay WB (2016) The cemented unipolar prosthesis for the management of displaced femoral neck fractures in the dependent osteopenic elderly. J Arthroplasty 31(5):1040–1046. https://doi.org/10.1016/j.arth.2015.11.029CrossRefPubMed

34.

Hopley C, Stengel D, Ekkernkamp A, Wich M (2010) Primary total hip arthroplasty versus hemiarthroplasty for displaced intracapsular hip fractures in older patients: systematic review. BMJ 340:c2332. https://doi.org/10.1136/bmj.c2332CrossRefPubMed

35.

Goh SK, Samuel M, Su DH, Chan ES, Yeo SJ (2009) Meta-analysis comparing total hip arthroplasty with hemiarthroplasty in the treatment of displaced neck of femur fracture. J Arthroplasty 24(3):400–406. https://doi.org/10.1016/j.arth.2007.12.009CrossRefPubMed

36.

Healy WL, Iorio R (2004) Total hip arthroplasty: optimal treatment for displaced femoral neck fractures in elderly patients. Clin Orthop Relat Res 429:43–48CrossRef

37.

Kyle RF (2009) Fractures of the femoral neck. Instr Course Lect 58:61–68PubMed

38.

Grosso MJ, Danoff JR, Murtaugh TS, Trofa DP, Sawires AN, Macaulay WB (2017) Hemiarthroplasty for displaced femoral neck fractures in the elderly has a low conversion rate. J Arthroplasty 32(1):150–154. https://doi.org/10.1016/j.arth.2016.06.048CrossRefPubMed

39.

Rogmark C, Johnell O (2005) Orthopaedic treatment of displaced femoral neck fractures in elderly patients. Disabil Rehabil 27(18–19):1143–1149. https://doi.org/10.1080/09638280500055933CrossRefPubMed

40.

Chalmers BP, Perry KI, Hanssen AD, Pagnano MW, Abdel MP (2017) Conversion of hip hemiarthroplasty to total hip arthroplasty utilizing a dual-mobility construct compared with large femoral heads. J Arthroplasty 32(10):3071–3075. https://doi.org/10.1016/j.arth.2017.04.061CrossRefPubMed

Title: Hemiarthroplasty versus total arthroplasty for displaced femoral neck fractures in the elderly: meta-analysis of randomized clinical trials
Authors: Filippo Migliorini
Andromahi Trivellas
Arne Driessen
Valentin Quack
Yasser El Mansy
Hanno Schenker
Markus Tingart
Jörg Eschweiler
Publication date: 01-11-2020
Publisher: Springer Berlin Heidelberg
Keywords: Hip-TEP
Hip-TEP
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 11/2020
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-020-03409-3

At a glance: The STEP trials

Springer Medicine

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

Abstract

Introduction

Materials and methods

Results

Conclusion

Level of evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusion

Level of evidence

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