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Internal Fixation Versus Arthroplasty for Displaced Femoral Neck Fractures: What is the Evidence?

Heetveld, Martin J.; Rogmark, Cecilia LU ; Frihagen, Frede and Keating, John (2009) In Journal of Orthopaedic Trauma 23(6). p.395-402
Abstract
A review of the current evidence for internal fixation versus hemiarthroplasty versus primary total hip arthroplasty for displaced femoral neck fractures was undertaken. At the meta-analysis level no difference in postoperative pain, function, or quality of life can yet be demonstrated. A significant difference in mortality has also not been found, but a trend towards higher mortality after primary arthroplasty is possible. Internal fixation (IF) has less morbidity, but a higher risk of revision and less cost-effectiveness. Independent adjudication for IF technique is rare in studies and bias towards higher revision rates due to technical failure is an issue. Randomized trials comparing IF with arthroplasty remain underpowered in specific... (More)
A review of the current evidence for internal fixation versus hemiarthroplasty versus primary total hip arthroplasty for displaced femoral neck fractures was undertaken. At the meta-analysis level no difference in postoperative pain, function, or quality of life can yet be demonstrated. A significant difference in mortality has also not been found, but a trend towards higher mortality after primary arthroplasty is possible. Internal fixation (IF) has less morbidity, but a higher risk of revision and less cost-effectiveness. Independent adjudication for IF technique is rare in studies and bias towards higher revision rates due to technical failure is an issue. Randomized trials comparing IF with arthroplasty remain underpowered in specific subgroups of patients, in which IF revision rates could be acceptable. In hemiarthroplasty the data suggest minimal differences in outcome between the prosthesis types. The cementless Austin-Moore prosthesis is out-dated. Currently a cemented unipolar or bipolar, depending on costs, hemi-arthroplasty is the treatment of choice for an elderly patient with functional limitations before the fracture. The role of modern, uncemented hemiarthroplasty designs are uncertain until more data are published. Total hip arthroplasty (THA) should be considered in any active older patient with a displaced femoral neck fracture. Patients with concomitant osteoarthritis, rheumatoid arthritis, or renal failure do poorly with other treatment options and Should be treated with THA. Randomized trials have shown THA to be a cost-effective treatment with lower revision rates than IF THA may also appear to be superior to hemiarthroplasty in specific subgroups, but larger trials are needed to confirm this observation. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
hemiarthroplasty, femoral neck fracture, internal fixation, total hip, arthroplasty
in
Journal of Orthopaedic Trauma
volume
23
issue
6
pages
395 - 402
publisher
Lippincott Williams & Wilkins
external identifiers
  • wos:000267499500003
  • scopus:67651049556
ISSN
0890-5339
language
English
LU publication?
yes
id
a2406dd0-3a41-41ca-956c-17d0590509ec (old id 1463074)
date added to LUP
2009-08-31 10:53:23
date last changed
2017-07-09 03:58:22
@article{a2406dd0-3a41-41ca-956c-17d0590509ec,
  abstract     = {A review of the current evidence for internal fixation versus hemiarthroplasty versus primary total hip arthroplasty for displaced femoral neck fractures was undertaken. At the meta-analysis level no difference in postoperative pain, function, or quality of life can yet be demonstrated. A significant difference in mortality has also not been found, but a trend towards higher mortality after primary arthroplasty is possible. Internal fixation (IF) has less morbidity, but a higher risk of revision and less cost-effectiveness. Independent adjudication for IF technique is rare in studies and bias towards higher revision rates due to technical failure is an issue. Randomized trials comparing IF with arthroplasty remain underpowered in specific subgroups of patients, in which IF revision rates could be acceptable. In hemiarthroplasty the data suggest minimal differences in outcome between the prosthesis types. The cementless Austin-Moore prosthesis is out-dated. Currently a cemented unipolar or bipolar, depending on costs, hemi-arthroplasty is the treatment of choice for an elderly patient with functional limitations before the fracture. The role of modern, uncemented hemiarthroplasty designs are uncertain until more data are published. Total hip arthroplasty (THA) should be considered in any active older patient with a displaced femoral neck fracture. Patients with concomitant osteoarthritis, rheumatoid arthritis, or renal failure do poorly with other treatment options and Should be treated with THA. Randomized trials have shown THA to be a cost-effective treatment with lower revision rates than IF THA may also appear to be superior to hemiarthroplasty in specific subgroups, but larger trials are needed to confirm this observation.},
  author       = {Heetveld, Martin J. and Rogmark, Cecilia and Frihagen, Frede and Keating, John},
  issn         = {0890-5339},
  keyword      = {hemiarthroplasty,femoral neck fracture,internal fixation,total hip,arthroplasty},
  language     = {eng},
  number       = {6},
  pages        = {395--402},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {Journal of Orthopaedic Trauma},
  title        = {Internal Fixation Versus Arthroplasty for Displaced Femoral Neck Fractures: What is the Evidence?},
  volume       = {23},
  year         = {2009},
}