Meta-analysis of randomised controlled trials comparing unipolar with bipolar hemiarthroplasty for displaced femoral-neck fractures

Abstract

Purpose: Unipolar and bipolar hemiarthroplasty (HA) are used to treat displaced femoral-neck fractures. However, which type is best for treating displaced femoral-neck fractures in elderly patients remains a subject for debate. Our aim was to review randomised controlled trials to establish which type provides superior clinical outcome for this patient population. Methods: We searched PubMed, Embase and Cochrane Register of Controlled Trials databases and Web of Science for randomised controlled trials (RCTs) comparing unipolar with bipolar HA to treat femoral-neck fracture in the elderly. Risk ratios (RRs) and mean differences (MDs) from each trial were pooled using random-effects or fixed-effects models depending on study heterogeneity. Analysis was performed using RevMan5.2 from the Cochrane Collaboration. Results: A total of 1,100 patients from nine studies were assessed in this meta-analysis. Results showed no significant differences in function score [MD = -0.14, 95% confidence interval (CI) -2.42-2.13], mortality (RR = 0.97, 95% CI 0.65-1.46), dislocation (RR = 1.33, 95 % CI 0.53-3.34), deep infection (RR = 0.79, 95 % CI 0.35-1.79), acetabular erosion (RR = 1.99, 95 % CI 0.61-6.52), operating time (MD = 2.14, 95 % CI -9.85 to14.14), blood loss (MD = 13.40, 95 % CI -49.60 to 76.39) and length of hospital stay (MD = 0.12, 95 % CI -0.49to0.73) between unipolar and bipolar HA. Conclusions: Unipolar and bipolar HA achieved similar clinical outcomes in patients with displaced femoral-neck fractures. © 2014 Springer-Verlag.