Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany.
Department of Orthopaedics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Arch Orthop Trauma Surg. 2020 Nov;140(11):1695-1704. doi: 10.1007/s00402-020-03409-3. Epub 2020 Mar 13.
Displaced femoral neck fractures (FNF) are complicated by high mortality rates and continue to represent an important cause of disability, having a negative impact on patient mobility and physical independence. The purpose of this study was to update and analyse current outcomes and evidence concerning hip hemiarthroplasty (HHA) versus total hip arthroplasty (THA) for displaced femoral neck fractures in the elderly. Thus, a meta-analysis of randomized clinical trials was conducted.
This meta-analysis was conducted according to the PRISMA guidelines. In October 2019, the following databases were accessed: Embase, Google Scholar, Pubmed, Scopus. All randomized clinical trials (RCTs) comparing total hip arthroplasty versus hip hemiarthroplasty for displaced femoral neck fractures were included in the present study. For the statistical analysis and the methodological quality assessment, the Review Manager Software 5.3 (The Nordic Cochrane Collaboration, Copenhagen) and STATA/MP Software 14.1 (StataCorp, College Station, TX) were used.
Data from 2325 (1171 HHA vs 1154 THA) patients were collected. The mean follow-up was 58.12 months. The HHA group reported lower values of the mean Harris hip score (EE 3.22; p = 0.2), surgical duration (EE 21.75; p < 0.0001), length of the hospitalization stay (EE 0.8; p = 0.4). The HHA group evidenced lower dislocations rate (OR 1.78; p = 0.01, Fig. 4), but higher rate of acetabular erosion (OR 0.08; p = 0.0006). At a mean of 58.12 ± 52.8 months follow-up, revisions rate scored reduced in the THA group (OR 0.76; p = 0.2). Subgroup analysis of RCTs < 5 years follow-up revealed reduced revision in favour of the HHA group (OR 2.19; p = 0.03), while subgroup analysis of RCTs > 5 years follow-up revealed reduced revision in favour of the THA group (OR 0.25; p = 0.0003). The Kaplan-Meier curve detected similarity of patients survivorship between the two groups (HR 1.06; p = 0.3).
For the elderly population, both HHA and THA are valid solutions to treat displaced femoral neck fractures, with comparable survivorship. HHA detected reduced dislocations, while for THA a lower risk of acetabular erosion and further revision surgeries were reported.
Level I, meta-analysis of randomized clinical trials.
移位股骨颈骨折（FNF）死亡率高，仍是导致残疾的重要原因，严重影响患者的活动能力和身体独立性。本研究旨在更新和分析目前关于老年移位股骨颈骨折的髋关节半髋关节置换术（HHA）与全髋关节置换术（THA）的疗效和证据。因此，我们进行了一项荟萃分析。
本研究根据 PRISMA 指南进行。2019 年 10 月，检索了以下数据库：Embase、Google Scholar、PubMed、Scopus。纳入了比较 THA 与 HHA 治疗移位股骨颈骨折的所有随机临床试验（RCT）。使用 Review Manager Software 5.3（北欧 Cochrane 协作组，哥本哈根）和 STATA/MP Software 14.1（StataCorp，德克萨斯州立大学）进行统计分析和方法学质量评估。
共纳入 2325 例（1171 例 HHA 与 1154 例 THA）患者。平均随访时间为 58.12 个月。HHA 组的平均 Harris 髋关节评分较低（均数差值[MD] 3.22；p=0.2），手术时间较短（MD 21.75；p<0.0001），住院时间较短（MD 0.8；p=0.4）。HHA 组脱位率较低（比值比[OR] 1.78；p=0.01，图 4），但髋臼侧侵蚀率较高（OR 0.08；p=0.0006）。在平均 58.12±52.8 个月的随访中，THA 组的翻修率降低（OR 0.76；p=0.2）。随访时间<5 年的 RCT 亚组分析显示，HHA 组的翻修率降低（OR 2.19；p=0.03），而随访时间>5 年的 RCT 亚组分析显示，THA 组的翻修率降低（OR 0.25；p=0.0003）。Kaplan-Meier 曲线显示两组患者的生存率相似（HR 1.06；p=0.3）。
对于老年人群，HHA 和 THA 都是治疗移位股骨颈骨折的有效方法，生存率相当。HHA 组的脱位率较低，而 THA 组的髋臼侧侵蚀和进一步翻修手术的风险较低。
I 级，随机临床试验的荟萃分析。
