Primary arthroplasty is better than internal fixation of displaced femoral neck fractures: a meta-analysis of 14 randomized studies with 2,289 patients

Acta Orthop. 2006 Jun;77(3):359-67. doi: 10.1080/17453670610046262.

Abstract

Background: The treatment of displaced femoral neck fractures has long been debated. 14 randomized controlled studies (RCTs) comparing internal fixation with primary arthroplasty may give material for evidence-based decision making.

Methods: Computerized databases were searched for RCTs published between 1966 and 2004. 14 RCTs containing 2,289 patients were included in a metaanalysis regarding complications, reoperations and mortality. The analysis was performed with software from the Cochrane collaboration.

Results: Primary arthroplasty leads to significantly fewer major method-related hip complications and reoperations, compared to internal fixation. There was no significant difference in mortality between the two groups at 30 days and 1 year. Most of the studies found better function and less pain after primary arthroplasty.

Interpretation: Primary arthroplasty should be used in most patients with displaced femoral neck fracture. The healthy, lucid individual, 70-80 years old, should be given a total hip arthroplasty. The older, impaired or institutionalized patient would benefit from a hemiarthroplasty.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Review

MeSH terms

  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Hip* / adverse effects
  • Evidence-Based Medicine
  • Femoral Neck Fractures / surgery*
  • Follow-Up Studies
  • Fracture Fixation, Internal / adverse effects
  • Humans
  • Randomized Controlled Trials as Topic
  • Reoperation
  • Treatment Outcome