Total Hip Replacement Versus Internal Fixation For Femoral Neck Fractures In Elderly Patients: A Systematic Review

Objective To evaluate the effectiveness of total hip replacement versus internal fixation for femoral neck fractures in elderly patients.Methods Randomized controlled trials (RCTs ) and clinical controlled trials (CCTs ) were identified f rom MEDLINE (1966-2006.5) , EMBASE (1966～2006.5) , Cochrane Library (Issue 1 , 2006) , Cochrane Musculoskeletal Injuries Group Database (2006.5) , and CBM disc (1979 -2006.5) . We handsearched Chinese Journal of Orthopaedy (f rom establishment to May 2006) and Orthopaedic Journal of China (f rom establishment to May 2006). RCTs and CCTs were included.Data were extracted by two reviewers with designed extraction form.RevMan 4.2.8 software was used for data analysis. Results Eight RCTs were included. The combined results of meta-analysis showed that compared with internal fixation, total hip replacement can reduce the rate of reoperation (RR=0.15,95%C(I0.09,0.26),p=0.58) and the rate of hip pain after operation (RR=0.70,95%CI(0.59,0.85),p=0.10).Conclusions Compared with internal fixation, total hip replacement can reduce the rate of reopreation and the rate of hip pain after operation. However , the relation between the two operations and pulmonary complications , the time of union , infection , operative time , blood loss and evaluation of economy needs further study.