Internal fixation compared with arthroplasty for displaced XXXX . A meta-analysis.

@entity1 @entity162 @entity2249 @entity190 @entity281 @entity158 @entity204
BACKGROUND: The optimal choice for the stabilization of displaced @entity2249 remains controversial, with alternatives including arthroplasty and internal fixation. Our objective was to determine the effect of arthroplasty (hemiarthroplasty, @entity162 , and total hip arthroplasty), compared with that of internal fixation, on rates of mortality, revision, @entity158 , function, operating time, and wound @entity281 in @entity1 with a displaced @entity2249 . METHODS: We searched computerized databases for randomized clinical trials published between 1969 and 2002, and we identified additional studies through hand searches of major orthopaedic journals, bibliographies of major orthopaedic textbooks, and personal files. Of 140 citations initially identified, fourteen met all eligibility criteria. Three investigators independently graded study quality and abstracted relevant data, including information on revision and mortality rates. RESULTS: Nine trials, which included a total of 1162 @entity1 , provided detailed information on mortality rates over the first four postoperative months, which ranged from 0% to 20%. We found a trend toward an increase in the relative risk of @entity204 in the first four months after arthroplasty compared with the risk in the first four months after internal fixation (relative risk, 1.27). At one year, the relative risk of @entity204 was 1.04. The risk of @entity204 after arthroplasty appeared to be higher than that after fixation with a compression screw and side-plate but not higher than that after internal fixation with use of screws only (relative risk = 1.75 and 0.86, respectively; p < 0.05). Fourteen trials that included a total of 1901 @entity1 provided data on revision surgery. The relative risk of revision surgery after arthroplasty compared with the risk after internal fixation was 0.23 (p = 0.0003). @entity158 relief and the attainment of overall good function were similar in @entity1 treated with arthroplasty and those treated with internal fixation (relative risk, 1.12 for @entity158 relief and 0.99 for function). Infection rates ranged from 0% to 18%, and arthroplasty significantly increased the risk of @entity281 (relative risk, 1.81; p = 0.009). In addition, @entity1 who underwent arthroplasty had greater @entity190 and longer operative times than those who were treated with internal fixation. CONCLUSIONS: In comparison with internal fixation, arthroplasty for the treatment of a displaced @entity2249 significantly reduces the risk of revision surgery, at the cost of greater @entity281 rates, @entity190 , and operative time and possibly an increase in early mortality rates. Only larger trials will resolve the critical question of the impact on early mortality.
