A Meta-analysis On The Effects Of Total Hip Replacement Versus Internal Fixation For Treatment Of Femoral Neck Fractures In Elderly Patients

Objective: To evaluate the effects of total hip replacement versus internal fixation for treatment of femoral neck fractures in elderly patients on the case- fatality rate after operation 12- 24 months ,the rates of reoperation and rates of pain of hip joint after operation.Methods: Randomized controlled trials (RCT) and retrospective studys were identified from PUBMED, Ovid, CHKD and the "WEI PU" database. RCTs and CCTs were included. The quality of trials was critically assessed. Data were extracted from these trials and data analysis was performed by RevMan4.2.8.Results: This meta-analysis included a total of six randomized controlled trials, a retrospective study. Six Literatures reported the case-fatality rates of after operation in 12- 24 months in total hip replacement and internal fixation for treatment of femoral neck fractures, a total of 532 cases, of which acceptance total hip replacement in 260 cases, acceptance internal fixation in 272 cases, The combined results of meta- analysis showed that compared with internal fixation, total hip replacement could not reduce the rate of the case -fatality (OR=0.75, 95%CI [0.47, 1.19]) . Six Literatures reported the rate of reoperation in total hip replacement and internal fixation for treatment of femoral neck fractures in elderly patients on the case-fatality rate after operation 12- 24 months, a total of 526 cases, of which acceptance total hip replacement in 252 cases, acceptance internal fixation in 274 cases, The combined results of meta- analysis showed that compared with internal fixation, total hip replacement could reduce the rate of reoperation (OR=0.19, 95%CI [0.10, 0.35]) . Four Literatures reported the rate of hip pain after operation in total hip replacement and internal fixation for treatment of femoral neck fractures in elderly patients on the case- fatality rate after operation 12- 24 months, a total of 446 cases, of which acceptance total hip replacement in 219 cases, acceptance internal fixation in 227 cases, The combined results of meta-analysis showed that compared with internal fixation, total hip replacement could not reduce the rate of hip pain after operation (OR=0.63, 95%CI [0.30, 1.35]).Conclusion: compared with internal fixation, total hip replacement could reduce the rate of reoperation,but total hip replacement could reduce neither the rate of hip pain after operation nor the rate of the case-fatality. However, the relation between the two operations and pulmonary complications, the time of union, infection, operative time, blood loss and evaluation of economy needs further study.