Meta-Analysis Comparing Arthroplasty with Internal Fixation for Displaced Femoral Neck Fracture in the Elderly

Background The treatment of displaced femoral neck fracture includes internal fixation and arthroplasty. However, which is the best surgical treatment for the elderly patient with displaced femoral neck fractures has been controversial. Our objective was to compare the clinical effects of internal fixation with that of arthroplasty for displaced femoral neck fracture in the elderly (≥60 y of age). Materials and Methods We searched for all randomized controlled trials of hip arthroplasty versus internal fixation for displaced femoral neck fractures in the elderly by electronically searching PUBMED (1966 to December, 2008), MEDILINE (1966 to December, 2008) and manually searching grey literatures. The quality of the trials was assessed and meta-analyses were conducted using the Cochrane Collaboration's RevMan 4.2 software. Results Nineteen published randomized controlled trials involving a total of 3505 patients were suitable for inclusion in the review. The combined results of meta-analyses showed no significant difference in mortality at 1 y postoperatively between the two methods. However, compared with internal fixation, arthroplasty could reduce the rate of reoperations and the major method-related complications. Conclusions Compared with internal fixation, arthroplasty can not only reduce the surgical revision, but also decrease the incidence of complications, and does not increase mortality. The present meta-analysis shows that there is an evidence base to support arthroplasty as a primary treatment for displaced femoral neck fractures in the elderly.