Hemiarthroplasty versus total arthroplasty for displaced femoral neck fractures in the elderly: meta-analysis of randomi
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Hemiarthroplasty versus total arthroplasty for displaced femoral neck fractures in the elderly: meta‑analysis of randomized clinical trials Filippo Migliorini1 · Andromahi Trivellas2 · Arne Driessen1 · Valentin Quack1 · Yasser El Mansy1,3 · Hanno Schenker1 · Markus Tingart1 · Jörg Eschweiler1 Received: 7 November 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction 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. Materials and methods 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. Results 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 70 years old were considered. Articles published before 2000 were excluded, as were those treating animals, biomechanics, cadaveric, or in vitro studies. Studies treating revision surgeries were excluded. Studies evaluating these procedures through the addition of adjuvants, such as stem cells, PRP, or any other infiltrations, were excluded. Disagreements between the authors were debated and mutually solved.
Outcomes of interest Two independent authors (FM, JE) exported data of interest from each clinical trial. The demographic data exported were the following: author, year of the publication, number of enrolled hips, and duration of the follow-up (months). Successively, the included articles were divided into two study groups: THA, HHA. The following data were extracted: number of enrolled hips, percentage of female patients, mean age of the samples, Harris hip score [25], surgical duration, duration of hospitalization. Further dislocation, acetabular erosion and revision surgeries were collected for each group, along with patient mortality.
Methodological quality assessment For the methodological quality assessment, the Review Manager Software Version 5.3 (The Nordic Cochrane Centre, Copenhagen) was used. Two authors (FM, JE) independently performed the assessment. The aforementioned tool analyses the included articles with reg
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