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Interventions for treating displaced intracapsular femoral neck fractures in the elderly: a Bayesian network meta-analysis of randomized controlled trials.

ABSTRACT: Displaced intracapsular femoral neck (AO type 31 B2/3) fractures have various treatments, including internal fixation (IF), unipolar uncemented hemiarthroplasty (HA), bipolar uncemented HA, unipolar cemented HA, bipolar cemented HA, uncemented total hip replacement (THR), and cemented THR. Systematic literature retrieval was performed from the databases to compare them in a network meta-analysis. Forty studies (85 arms) containing 6141 patients were included. Overall, our network meta-analysis rank the orders of 7 procedures in reoperation, mortality, dislocation and infection, which indicates that IF may provide the highest reoperation incidence, unipolar cemented HA may provide the lowest reoperation incidence; uncemented THR contributes the highest dislocation incidence; and bipolar uncemented HA provides the lowest infection incidence. No differences in mortality were observed among the treatments. This conclusion is indirect; higher-quality direct comparisons are required.

SUBMITTER: Zhang BF

PROVIDER: S-EPMC5638843 | biostudies-other | 2017 Oct

REPOSITORIES: biostudies-other

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Interventions for treating displaced intracapsular femoral neck fractures in the elderly: a Bayesian network meta-analysis of randomized controlled trials.

Zhang Bin-Fei BF Wang Peng-Fei PF Huang Hai H Cong Yu-Xuan YX Wang Hu H Zhuang Yan Y

Scientific reports 20171012 1

Displaced intracapsular femoral neck (AO type 31 B2/3) fractures have various treatments, including internal fixation (IF), unipolar uncemented hemiarthroplasty (HA), bipolar uncemented HA, unipolar cemented HA, bipolar cemented HA, uncemented total hip replacement (THR), and cemented THR. Systematic literature retrieval was performed from the databases to compare them in a network meta-analysis. Forty studies (85 arms) containing 6141 patients were included. Overall, our network meta-analysis r ...[more]

PMID: 29026135

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Project description:BackgroundCurrently, there are 2 mainstream treatments for displaced femoral neck fracture, including internal fixation and arthroplasty. However, there are still some controversial problems as to which treatment should be primarily chosen.MethodsThe relevant studies comparing arthroplasty with internal fixation were searched in the databases of PubMed, Embase, and Cochrane Library. Finally, 31 relevant randomized controlled trials were included in this meta-analysis. The quality of studies was evaluated and meta-analyses were performed using RevMan 5.3 software. We also assessed the heterogeneity among studies and publication bias via the I-squared index and forest plots.ResultsThere was no significant difference between arthroplasty and internal fixation groups in patient mortality at both short-term and long-term points. However, patients treated with arthroplasty showed significantly lowered risks of reoperation both at short-term (5.6% vs 31.5%; relative risks (RR) = 0.19; 95% CI, 0.13-0.28; P < .00001) and long-term follow-up (9.5% vs 45.9%; RR = 0.23; 95% CI, 0.17-0.33; P < .00001). Similarly, arthroplasty-treated patients demonstrated a significant decrease in the risk of postoperation complications at short-term (10.3% vs 34.4%; RR = 0.37, 95% CI, 0.24-0.57; P < .00001) and long-term follow-up (11.7% vs 42.5%; RR = 0.30, 95% CI, 0.16-0.57; P < .0002). Besides, patients in the arthroplasty group were associated with better alleviation of pain postoperation (18.3% vs 31.1%; RR = 0.50, 95% CI, 0.33-0.78; P = .002).In trial sequence analyses, all cumulative Z curves except that of mortality crossed the trial sequential monitoring boundaries and conventional boundaries, and required information size has been reached.ConclusionsArthroplasty leads to a lower rate of reoperation, a reduced risk of complications, and a better alleviation of postoperation pain both at short-term and long-term follow-up. Most importantly, and according to trial sequence analyses, more than enough evidence has been achieved that arthroplasty does show better outcomes than internal fixation in terms of reoperation rate, complications, and postoperation pain.Level of evidenceTherapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Dataset Information

Interventions for treating displaced intracapsular femoral neck fractures in the elderly: a Bayesian network meta-analysis of randomized controlled trials.

Publications

Interventions for treating displaced intracapsular femoral neck fractures in the elderly: a Bayesian network meta-analysis of randomized controlled trials.

Similar Datasets

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