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Replacement arthroplasty versus internal fixation for extracapsular hip fractures.
1Orthopaedic Department, Peterborough District Hospital, Thorpe Road, Peterborough, Cambridgeshire, UK, PE3 6DA. mjparker@globalnet.co.uk
The Cochrane Database of Systematic Reviews
|May 5, 2000
Summary
For extracapsular hip fractures, evidence comparing hip replacement arthroplasty with internal fixation is limited. More high-quality randomized trials are needed to determine if arthroplasty offers advantages over the sliding hip screw for these fractures.
Area of Science:
- Orthopedic surgery
- Traumatology
- Evidence-based medicine
Background:
- Internal fixation is a common treatment for extracapsular hip fractures but may fail in unstable cases.
- Hip replacement arthroplasty is an alternative, often used for intracapsular fractures.
Purpose of the Study:
- To compare replacement arthroplasty with internal fixation for treating adult extracapsular hip fractures.
Main Methods:
- Searched multiple databases and contacted experts for relevant randomized and quasi-randomized trials.
- Included skeletally mature patients with extracapsular hip fractures comparing arthroplasty and internal fixation.
- Assessed trial quality and extracted data, calculating odds ratios and confidence intervals.
Main Results:
- One poor-quality randomized trial of 90 patients with unstable trochanteric fractures was identified.
- No significant differences were found in operating time, wound complications, mortality, or mobility.
- The arthroplasty group reportedly required more blood transfusions.
Conclusions:
- Insufficient evidence exists from randomized trials to support arthroplasty over sliding hip screws for extracapsular hip fractures.
- Further well-designed randomized trials are necessary to compare these treatment options.