Primary hemiarthroplasty was associated with a non-significant increase in 30-day mortality compared with internal fixation, whereas internal fixation had a higher rate of failure.
Meta-Analysis
Does primary hemiarthroplasty compared with primary internal fixation affect mortality and complication rates in patients with displaced fractures of the femoral neck?
While internal fixation for displaced femoral neck fractures has a higher failure rate than arthroplasty, it offers the potential to regain normal hip function without a significant long-term mortality difference.
Author summary An increase in the rate of mortality at thirty days after primary hemiarthroplasty compared with that after primary internal fixation was observed, although the difference was not statistically significant and did not persist beyond three months. The absolute difference in perioperative mortality between the two groups was small. The rate of loss of fixation or reduction after internal fixation was higher than dislocations following unipolar, bipolar or total hip arthroplasty. An anterior operative approach for arthroplasty consistently was associated with a lower rate of mortality at two months than was a posterior approach. Although internal fixation was associated with a higher rate of failure, it offers patients the chance to regain normal function of the hip. Long-term follow-up of patients who have been managed with internal fixation is needed to assess whether the chance of long-term benefit is sufficient to offset the greater chance of failure in the first two years after surgery.
Lu‐Yao et al. (2005) conducted a meta-analysis in Displaced fractures of the femoral neck. Primary hemiarthroplasty vs. Primary internal fixation was evaluated on Mortality at thirty days. Primary hemiarthroplasty was associated with a non-significant increase in 30-day mortality compared with internal fixation, whereas internal fixation had a higher rate of failure.