Total hip arthroplasty versus artificial femoral head replacement for the effect of displaced femoral neck fracture: a meta-analysis of 14 randomized controlled trials

doi:10.12307/2021.207

Abstract

Abstract: OBJECTIVE: Displaced femoral neck fracture is a common fracture in the elderly, but the method of operation is still controversial. Previous meta-analysis has some shortcomings such as low quality of research and few cases. This study compared the efficacy of total hip arthroplasty and artificial femoral head replacement in the treatment of displaced femoral neck fracture by meta-analysis.
METHODS: PubMed, EMbase, Cochrane Library, Google Scholar, CNKI, Wanfang and VIP databases were searched by computer from January 1970 to June 2020. The key words were “femoral neck fracture, hemiarthroplasty, total hip arthroplasty” in English and Chinese. All articles about the comparative study of total hip arthroplasty and artificial femoral head replacement in the treatment of displaced femoral neck fracture were searched. Two researchers independently screened the literature according to the inclusion and exclusion criteria, extracted data, and evaluated the risk of literature bias according to Cochrane Handbook. Stata 14.0 statistical software and the updated Meta-Analysis software package were used to analyze the outcome measures.
RESULTS: (1) A total of 14 randomized controlled trials, containing 10 original studies and 4 extended follow-up data, were included in this article. A total of 2 523 patients with displaced femoral neck fracture were included. The experimental group was treated with total hip arthroplasty and the control group was treated with artificial femoral head replacement. The overall quality of the literature was high. (2) The results of meta-analysis showed that the dislocation rate (RR=0.450, 95%CI:0.306-0.661, P < 0.001), Harris score (WMD=-5.527, 95%CI:-7.952 to -3.103, P < 0.001), and EQ-5D score (WMD=-0.055, 95%CI:-0.075 to -0.034, P < 0.001) in the total hip arthroplasty group were higher than those in the artificial femoral head replacement group. However, the second operation rate of total hip arthroplasty group was lower than that of artificial femoral head replacement group (RR=1.741, 95%CI:1.253-2.419, P=0.001). There was no statistical difference in 2-year mortality (RR=1.025, 95%CI:0.845-1.243, P=0.804), postoperative infection rate (RR=0.896, 95%CI:0.789-1.017, P=0.505), and incidence of systemic complications (RR=0.896, 95%CI:0.789-1.017, P=0.090) between the two groups.
CONCLUSION: The available clinical evidence shows that total hip arthroplasty has better hip movement function and lower secondary operation rate. For patients with displaced femoral neck fracture who are in good physical condition, can move alone before fracture, and have good cognitive function, total hip arthroplasty has more advantages than artificial femoral head replacement.

Key words: bone, hip, fracture, femoral neck, femoral head, joint arthroplasty, femoral stem prosthesis, randomized controlled trial, meta-analysis

CLC Number:

Lü Hui, Huang Denghua, Zou Longfei, Xue Hao, Xie Zonghui, Yu Peigen, Tan Meiyun. Total hip arthroplasty versus artificial femoral head replacement for the effect of displaced femoral neck fracture: a meta-analysis of 14 randomized controlled trials[J]. Chinese Journal of Tissue Engineering Research, 2021, 25(27): 4421-4428.

Figures/Tables 15

References

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