This 2003 meta-analysis pooled 14 RCTs (up to 1901 patients) comparing arthroplasty versus internal fixation for displaced femoral neck fractures in patients ≥65. It quantifies the trade-offs across revision rates, mortality, infection, pain, function, blood loss, and operative time. It remains the foundational Level I evidence base that shaped modern management of this fracture.
The decision to fix or replace a displaced femoral neck fracture in an elderly patient is not just about the index operation — it is about what happens over the next year.
This meta-analysis puts the best available RCT data behind what many surgeons already suspected: arthroplasty dramatically cuts reoperation risk (NNT = 6) but adds infection risk, blood loss, and a worrying early mortality trend that the data cannot rule out.
When you see a displaced femoral neck fracture in a patient ≥65, arthroplasty is the default. In cognitively impaired patients, the revision benefit is even more pronounced (RR 0.05 vs. Screws alone), making arthroplasty the clear choice in that subgroup.
The mortality finding deserves nuance: arthroplasty's early mortality disadvantage was statistically significant only versus compression screw and side-plate fixation, not versus cannulated screws. The fixation comparator matters when interpreting any mortality data in this literature.
This paper directly motivated the HEALTH trial, which ultimately confirmed arthroplasty's superiority for displaced femoral neck fractures in patients ≥45. Validating the signal Bhandari identified here.
This 2003 meta-analysis pooled 14 RCTs (up to 1901 patients) comparing arthroplasty versus internal fixation for displaced femoral neck fractures in patients ≥65. It quantifies the trade-offs across revision rates, mortality, infection, pain, function, blood loss, and operative time. It remains the foundational Level I evidence base that shaped modern management of this fracture.
The decision to fix or replace a displaced femoral neck fracture in an elderly patient is not just about the index operation — it is about what happens over the next year.
This meta-analysis puts the best available RCT data behind what many surgeons already suspected: arthroplasty dramatically cuts reoperation risk (NNT = 6) but adds infection risk, blood loss, and a worrying early mortality trend that the data cannot rule out.
When you see a displaced femoral neck fracture in a patient ≥65, arthroplasty is the default. In cognitively impaired patients, the revision benefit is even more pronounced (RR 0.05 vs. Screws alone), making arthroplasty the clear choice in that subgroup.
The mortality finding deserves nuance: arthroplasty's early mortality disadvantage was statistically significant only versus compression screw and side-plate fixation, not versus cannulated screws. The fixation comparator matters when interpreting any mortality data in this literature.
This paper directly motivated the HEALTH trial, which ultimately confirmed arthroplasty's superiority for displaced femoral neck fractures in patients ≥45. Validating the signal Bhandari identified here.