Total Hip Arthroplasty Versus Hemiarthroplasty For Displaced Femoral Neck Fractures:a Meta-Analysis

Objectives Femoral neck fractures(DFNF)is a common type of fracture in the elderly and can be treated by other surgical methods such as internal fixation,Hemiarthroplasty(HA)or Total hip arthroplasty(THA).However,there is no consensus among clinicians as to which surgical method is more effective in treating DFNF.In this paper,a systematic meta-analysis was conducted to compare the efficacy of HA and THA.Methods Through retrieval in CNKI database,Wanfang Database,Pubmed,Web of Science,Medline,Cochrane Central Register of Controlled Trials,Embase and other databases,Controlled Trials of HA and THA therapy for DFNF were obtained from January 2000 to January 2020.The quality of the included literature was evaluated according to the Meta analysis standards,and the heterogeneity test and Meta analysis of the included literature were performed using Revman5.3 software.Relativerisk(RR)was used to represent the counting data,and weight mean difference was used to represent the measurement data.95%confidence interval(CI)was used for both expressions,and the hypothetical test level P=0.05 was set.ResultA In the end,32 studies were included,involving a total of 3470 patients,including 1671 patients treated with THA and 1799 patients treated with HA.Meta analysis results:compared the efficacy of HA and THA in the treatment of DFNF,there were no statistically significant differences in age,underlying disease,Harris score 1 year after surgery and length of hospital stay between the two surgical methods(P>0.05),and the postoperative complications of HA group were higher than THA group[RR=1.33,95%CI(1.10,1.62),P=0.003].The operative time of THA group was significantly higher than that of HA[SMD=-2.43,95%CI(-3.05,-1.81),P<0.001].More blood loss occurred in THA group[SMD=-2.51,95%CI(-3.23,-1.79),P<0.001].The postoperative drainage volume in THA group was higher[SMD=-1.53,95%CI(-2.23,-0.83),P<0.001].The blood transfusion volume in THA’ group was higher[SMD=-1.79,95%CI(-3.01,-0.57),P=0.004].THA group had higher hospitalization costs[SMD=-4.19,95%CI(-5.98,-2.39),P<0.001].Conclusion According to Meta analysis results,there was no difference in Harris scores 1 year after operation between the two methods,but there were more patients with postoperative hip pain in the semi-hip replacement group.Therefore,it is suggested in this paper that preoperative sensitivity should be evaluated in the treatment of patients with displaced femoral neck fracture,and total hip replacement should be preferred for patients who cannot tolerate pain.Due to the limited quantity and quality of the literature included in this paper,the conclusions of this paper need to be verified by a lot of clinical practice and high-quality systematic evaluation.