Hopley, BMJ 2010 - Primary Total Hip Arthroplasty versus Hemiarthroplasty for Displaced Intracapsular Hip Fractures in Older Patients: Systematic Review

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Primary Total Hip Arthroplasty versus Hemiarthroplasty for Displaced Intracapsular Hip Fractures in Older Patients: Systematic Review

Hopley, Wich, et al.·BMJ·2010·293 citations·Meta-analysis

Free Full Text·DOI·PubMed

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Study Question

Do patients aged over 60 treated with total hip arthroplasty for displaced fractures of the femoral neck have a lower risk of local and systemic complications and better functional outcomes than those treated with hemiarthroplasty?

Summary Answer

In older patients with femoral neck fractures, single stage total hip arthroplasty is associated with a lower risk of reoperation and better function but a higher risk of dislocation and general complications compared with hemiarthroplasty.

What Is Known and What This Paper Adds

Displaced femoral neck fractures are common surgical conditions and arthroplasty has been shown to produce better results than internal fixation. It is unclear whether fractured hips should be replaced by total hip arthroplasty or hemiarthroplasty in the emergency setting. A comprehensive review of the entire body of comparative evidence was carried out to compare important clinical outcomes between the two types of endoprostheses.

Main Results

Overall, 202 of 3821 references were scrutinised in full.
15 were eligible for inclusion: 4 randomised trials (n=421), 3 quasirandomised studies (n=355), and 8 cohort studies (n=1114).
Total hip arthroplasty was associated with a lower risk of reoperation compared with hemiarthroplasty (relative risk 0.57, 95% confidence interval 0.34 to 0.96, risk difference 4.4%, 95% confidence interval 0.2% to 8.5%).
Total hip arthroplasty also showed consistently better ratings in the Harris hip score (weighted mean difference 5.4, 95% confidence interval 2.7 to 8.2) after follow-up periods ranging from 12 to 48 months.
However, total hip arthroplasty was also associated with a slightly higher risk of dislocation (relative risk 1.48, 95% confidence interval 0.89 to 2.46) and general complications (1.14, 0.87 to 1.48).
The risk of deep infections and one year mortality did not differ.

Copyright remains with the authors and publisher.

Primary Total Hip Arthroplasty versus Hemiarthroplasty for Displaced Intracapsular Hip Fractures in Older Patients: Systematic Review.

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|

Primary Total Hip Arthroplasty versus Hemiarthroplasty for Displaced Intracapsular Hip Fractures in Older Patients: Systematic Review

Hopley, Wich, et al.·BMJ·2010·293 citations·Meta-analysis

Free Full Text·DOI·PubMed

|

Study Question

Do patients aged over 60 treated with total hip arthroplasty for displaced fractures of the femoral neck have a lower risk of local and systemic complications and better functional outcomes than those treated with hemiarthroplasty?

Summary Answer

In older patients with femoral neck fractures, single stage total hip arthroplasty is associated with a lower risk of reoperation and better function but a higher risk of dislocation and general complications compared with hemiarthroplasty.

What Is Known and What This Paper Adds

Displaced femoral neck fractures are common surgical conditions and arthroplasty has been shown to produce better results than internal fixation. It is unclear whether fractured hips should be replaced by total hip arthroplasty or hemiarthroplasty in the emergency setting. A comprehensive review of the entire body of comparative evidence was carried out to compare important clinical outcomes between the two types of endoprostheses.

Main Results

Overall, 202 of 3821 references were scrutinised in full.
15 were eligible for inclusion: 4 randomised trials (n=421), 3 quasirandomised studies (n=355), and 8 cohort studies (n=1114).
Total hip arthroplasty was associated with a lower risk of reoperation compared with hemiarthroplasty (relative risk 0.57, 95% confidence interval 0.34 to 0.96, risk difference 4.4%, 95% confidence interval 0.2% to 8.5%).
Total hip arthroplasty also showed consistently better ratings in the Harris hip score (weighted mean difference 5.4, 95% confidence interval 2.7 to 8.2) after follow-up periods ranging from 12 to 48 months.
However, total hip arthroplasty was also associated with a slightly higher risk of dislocation (relative risk 1.48, 95% confidence interval 0.89 to 2.46) and general complications (1.14, 0.87 to 1.48).
The risk of deep infections and one year mortality did not differ.

Copyright remains with the authors and publisher.

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