International Orthopaedics (SICOT) DOI 10.1007/s00264-014-2355-5
ORIGINAL PAPER
Meta-analysis of randomised controlled trials comparing unipolar with bipolar hemiarthroplasty for displaced femoral-neck fractures Yang Liu & Xueqiang Tao & Pei Wang & Zheng Zhang & Wenlong Zhang & Quan Qi
Received: 12 March 2014 / Accepted: 7 April 2014 # Springer-Verlag Berlin Heidelberg 2014
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.
Y. Liu : X. Tao : P. Wang : Z. Zhang : W. Zhang : Q. Qi (*) Department of Orthopaedics, The First Affiliated Hospital of Harbin Medical University, No. 23 You Zheng Street, Harbin 150001, China e-mail: [email protected]
Keywords Unipolar . Bipolar . Hemiarthroplasty . Displaced femoral-neck fractures
Introduction With the growing aging population and high prevalence of osteoporosis, there are approximately 1.5 million hip fractures worldwide per year, and there will be an estimated 3.9 million worldwide in 2050 [1]. Hip fractures in older patients are associated with impaired mobility, excess morbidity and mortality and obvious loss of independence [2, 3]. It is estimated that the annual medical costs owing to hip fractures will be more than US $15 billion at this time [4]. Displaced femoral-neck fractures account for about 50 % of the total hip fracture population [5]. Operative alternatives for displaced femoral-neck fractures include internal fixation, hemiarthroplasty (HA), and total hip arthroplasty (THA). HA is a common surgical procedure in elderly patients with displaced femoral-neck fractures, especially for the frail [6]. There are two different types of HA: unipolar and bipolar. Compared with unipolar HA with a single joint articulation, bipolar HA articulates at two different levels, and this design is thought to be associated with less acetabular wear and an increased range of motion (ROM) [7]. Theoretically, bipolar HA should decrease the amount of acetabular erosion and reduce pain [8]. Numerous studies [9–17] have compared clinical results of bipolar with unipolar HA. In a long-term follow-up trial comparing bipolar with unipolar prostheses, LaBelle et al. [7] found there was less pain and decreased acetabular protrusion in the bipolar group. In addition, Lestrange et al. [18] reviewed 496 patients with bipolar replacements for displaced femoral-neck fractures and compared them with patients having unipolar replacements. They concluded that the bipolar
International Orthopaedics (SICOT)
prosthesis offered advantages over one-piece designs in terms of fit, decreased acetabular erosion and improved function. However, in a prospective observational study based on the Swedish Hip Arthroplasty Register, Leonardsson et al. [19] found that bipolar implants had a higher risk of re-operation irrespective of cause (hazard ratio = 1.3), dislocation (1.4), infection (1.3) and periprosthetic fracture (1.7). There is still inadequate evidence to support the choice between unipolar and bipolar HA. Therefore, we designed this meta-analysis to quantitatively compare the clinical efficacy and complications of bipolar with unipolar HA for displaced femoral-neck fracture.
Methods This meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [20] for reporting systematic reviews and meta-analyses in healthcare interventions.
outcomes and follow-up. Divergences were resolved by consensus. Two authors independently appraised the quality of the included studies according to the Cochrane Collaboration guidelines (random sequence generation, allocation concealment, blinding, incomplete outcome data, selective reporting and other sources of bias) [21]; disagreements between authors were resolved by discussion. Statistical analyses Meta-analysis was done using Review Manager 5.2 software. Relative risks (RR) and 95 % confidence intervals (CI) were calculated for dichotomous outcomes, and mean differences (MD) and 95 % CI were calculated for continuous outcomes. We assessed heterogeneity among studies using the I2 statistic, judging values
ORIGINAL PAPER
Meta-analysis of randomised controlled trials comparing unipolar with bipolar hemiarthroplasty for displaced femoral-neck fractures Yang Liu & Xueqiang Tao & Pei Wang & Zheng Zhang & Wenlong Zhang & Quan Qi
Received: 12 March 2014 / Accepted: 7 April 2014 # Springer-Verlag Berlin Heidelberg 2014
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.
Y. Liu : X. Tao : P. Wang : Z. Zhang : W. Zhang : Q. Qi (*) Department of Orthopaedics, The First Affiliated Hospital of Harbin Medical University, No. 23 You Zheng Street, Harbin 150001, China e-mail: [email protected]
Keywords Unipolar . Bipolar . Hemiarthroplasty . Displaced femoral-neck fractures
Introduction With the growing aging population and high prevalence of osteoporosis, there are approximately 1.5 million hip fractures worldwide per year, and there will be an estimated 3.9 million worldwide in 2050 [1]. Hip fractures in older patients are associated with impaired mobility, excess morbidity and mortality and obvious loss of independence [2, 3]. It is estimated that the annual medical costs owing to hip fractures will be more than US $15 billion at this time [4]. Displaced femoral-neck fractures account for about 50 % of the total hip fracture population [5]. Operative alternatives for displaced femoral-neck fractures include internal fixation, hemiarthroplasty (HA), and total hip arthroplasty (THA). HA is a common surgical procedure in elderly patients with displaced femoral-neck fractures, especially for the frail [6]. There are two different types of HA: unipolar and bipolar. Compared with unipolar HA with a single joint articulation, bipolar HA articulates at two different levels, and this design is thought to be associated with less acetabular wear and an increased range of motion (ROM) [7]. Theoretically, bipolar HA should decrease the amount of acetabular erosion and reduce pain [8]. Numerous studies [9–17] have compared clinical results of bipolar with unipolar HA. In a long-term follow-up trial comparing bipolar with unipolar prostheses, LaBelle et al. [7] found there was less pain and decreased acetabular protrusion in the bipolar group. In addition, Lestrange et al. [18] reviewed 496 patients with bipolar replacements for displaced femoral-neck fractures and compared them with patients having unipolar replacements. They concluded that the bipolar
International Orthopaedics (SICOT)
prosthesis offered advantages over one-piece designs in terms of fit, decreased acetabular erosion and improved function. However, in a prospective observational study based on the Swedish Hip Arthroplasty Register, Leonardsson et al. [19] found that bipolar implants had a higher risk of re-operation irrespective of cause (hazard ratio = 1.3), dislocation (1.4), infection (1.3) and periprosthetic fracture (1.7). There is still inadequate evidence to support the choice between unipolar and bipolar HA. Therefore, we designed this meta-analysis to quantitatively compare the clinical efficacy and complications of bipolar with unipolar HA for displaced femoral-neck fracture.
Methods This meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [20] for reporting systematic reviews and meta-analyses in healthcare interventions.
outcomes and follow-up. Divergences were resolved by consensus. Two authors independently appraised the quality of the included studies according to the Cochrane Collaboration guidelines (random sequence generation, allocation concealment, blinding, incomplete outcome data, selective reporting and other sources of bias) [21]; disagreements between authors were resolved by discussion. Statistical analyses Meta-analysis was done using Review Manager 5.2 software. Relative risks (RR) and 95 % confidence intervals (CI) were calculated for dichotomous outcomes, and mean differences (MD) and 95 % CI were calculated for continuous outcomes. We assessed heterogeneity among studies using the I2 statistic, judging values
