• BACKGROUND
    • Most patients with displaced femoral neck fractures are treated by THA and hemiarthroplasty, but it remains uncertain which if either is associated with better function and lower risks of complications.
  • QUESTIONS/PURPOSES
    • We performed a meta-analysis of randomized controlled trials (RCTs) to determine whether THA was associated with lower rates of reoperations, mortality, complications, and better function compared with hemiarthroplasty.
  • METHODS
    • We searched the PubMed, Embase, Chinese Biomedicine Literature, and Cochrane Register of Controlled Trials databases and identified 12 RCTs (including a total of 1320 patients) for meta-analysis. Risk ratios (RRs) and weighted mean differences (WMDs) from each trial were pooled using random-effects or fixed-effects models depending on the heterogeneity of the included studies.
  • RESULTS
    • THA was associated with a lower risk of subsequent reoperations compared with hemiarthroplasty (RR = 0.53; 95% CI, 0.34-0.84). There was no difference in mortality between patients undergoing THA and hemiarthroplasty (RR = 0.81; 95% CI, 0.60-1.09). For complications, there was a higher risk of dislocation in patients undergoing THA (RR = 1.99; 95% CI, 1.26-3.15), but there were no differences in local infections (RR = 1.60; 95% CI, 0.74-3.46) and general complications (RR = 1.15; 95% CI, 0.91-1.45). Patients with THA had higher Harris hip scores at 1 year (WMD = 3.81; 95% CI, 0.87-6.74) and at 3 or 4 years (WMD = 10.07; 95% CI, 6.92-13.21).
  • CONCLUSIONS
    • Despite more dislocations, THA can benefit patients with displaced femoral neck fractures with a lower reoperation rate and higher functional scores.