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Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 8/2015

01-08-2015 | Clinical Research

Does Arthroplasty Provide Better Outcomes Than Internal Fixation At Mid- and Long-term Followup? A Meta-analysis

Authors: Jin Jiang, MD, PhD, Chen-hui Yang, MD, Qiao Lin, MD, Xiang-dong Yun, MD, PhD, Ya-yi Xia, MD, PhD

Published in: Clinical Orthopaedics and Related Research® | Issue 8/2015

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Abstract

Background

Arthroplasty has been shown to be superior regarding low risk of reoperation and better function score to internal fixation for treatment of displaced femoral neck fractures at short-term followup. However, there are unanswered questions regarding the efficacy of arthroplasty in the longer term compared with internal fixation.

Questions/purposes

We performed a meta-analysis comparing arthroplasty (hemiarthroplasty or THA) with internal fixation in patients with displaced femoral neck fractures with respect to (1) mortality, (2) reoperation, (3) functional recovery, and (4) complications, including only randomized trials with a minimum of 4 years followup.

Methods

Computerized databases, including PubMed (MEDLINE), EMBASE, Cochrane Register of Controlled Trials databases, and Web of Science™ were searched for studies published from the inception date for each database to March 2014. Eleven randomized controlled trials that compared arthroplasty (either hemiarthroplasty or THA) with internal fixation for treatment of patients with a femoral neck fracture were included in our analysis. The quality of the trials was assessed according to the Cochrane Handbook and meta-analyses were conducted using RevMan 5.2 software from the Cochrane Collaboration. The heterogeneity among studies was evaluated by the I-squared index (I2) and publication bias was assessed using forest plots.

Results

There were no differences between the internal fixation and arthroplasty groups for patient mortality at mid-term (48.4% vs 46.8%) or long-term followup (83.2% vs 81.5%). Arthroplasty was associated with a lower risk of reoperation at mid-term (7.2% vs 39.8%; relative risk [RR] = 0.10; 95% CI, 0.06–0.07) and at long-term followup (14.3% vs 43.8%; RR = 0.10; 95% CI, 0.06–0.07). Arthroplasty was associated with better functional recovery at mid-term followup (standard mean difference [SMD] = 0.55; 95% CI, 0.02–1.09), whereas function at long-term followup (SMD = 0.14; 95% CI, −0.35 to 0.62) was not different between the arthroplasty and internal fixation groups. There were no significant differences in subsequent ipsilateral fractures (1.5% vs 1.2%; RR = 2.18; 95% CI, 0.32–14.67; p = 0.42) and deep infections (2.7% vs 2.9%; RR = 0.89; 95% CI, 0.40–2.01; p = 0.78) between patients treated with arthroplasty and internal fixation.

Conclusions

Based on our results, we found that compared with internal fixation, arthroplasty may result in a lower rate of subsequent reoperation at mid- and long-term followup, and better mid-term functional recovery. Future studies should investigate the mid- and long-term results of THAs compared with hemiarthroplasty.
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Metadata
Title
Does Arthroplasty Provide Better Outcomes Than Internal Fixation At Mid- and Long-term Followup? A Meta-analysis
Authors
Jin Jiang, MD, PhD
Chen-hui Yang, MD
Qiao Lin, MD
Xiang-dong Yun, MD, PhD
Ya-yi Xia, MD, PhD
Publication date
01-08-2015
Publisher
Springer US
Published in
Clinical Orthopaedics and Related Research® / Issue 8/2015
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-015-4345-3

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