Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fracture: an overview of systematic reviews total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fracture: an overview of systematic reviews
Guilherme Guadagnini Falótico, Fábio Teruo Matsunaga, Jorge Sayum Filho, Vinícius Ynoe de Moraes, Marina Seike Garcia, Flávio Faloppa, Marcel Jun Sugawara Tamaoki, João Carlos Belloti
Abstract
BACKGROUND: hip arthroplasties for the treatment of displaced femoral neck fractures in adults can be total replacement or hemiarthroplasty. Despite the large number of studies on the topic, the best choice of arthroplasty to be used remains unclear. OBJECTIVES: overview the results of systematic reviews of randomized controlled trials (RCTs) comparing outcomes between total hip replacement and hemiarthroplasty for displaced femoral neck fractures in adults. DESIGN AND SETTING: The study followed the standards of the Prisma checklist and the Cochrane handbook. METHODS: Four electronic databases (Pubmed, Embase, Cochrane Library and Web of Science) were researched until January 2025. The primary outcomes were mortality, function, quality of life and revision rate and the secondary ones: dislocation, periprosthetic fracture, infection, and surgical time. Comparisons of dichotomous data were reported as the OR and 95% CI, and comparisons of functional and health related quality of life outcomes were reported as the mean difference and 95% CI. RESULTS: twenty systematic reviews with a total of 29,980 patients were analyzed. Patients with total hip arthroplasty had a lower revision rate (RR 0.67, 95% CI 0.48 to 0.93; participants = 4078; studies = 22; I2 = 30%), better early function (SMD 0.59, 95% CI 0.04 to 1.08; participants = 963; studies = 12; I2 = 87%) and better quality of life (DM 0.05, 95% CI 0.03 to 0.08; participants = 1240; studies = 6; I2 = 28%). There was no difference regarding dislocation, infection, periprosthetic fracture and mortality. Surgical time was shorter in hemiarthroplasty (DM 20.46, 95% CI 12.12 to 28, 80; participants = 1493; studies = 16; I2 = 95%). CONCLUSION: Total hip arthroplasty had a lower revision rate, better quality of life and function. The surgical time was on average 20 min shorter in hemiarthroplasty. Mortality, dislocation, infection, and periprosthetic fracture rates were similar. SYSTEMATIC REVIEW REGISTRATION: (CRD42021237885), and published in August 2021 ( https://bmjopen.bmj.com/content/11/11/e051840.long ).