Meta-analysis Surprise: Hemarthroplasty Beats ORIF for Non-displaced Femoral Neck Fractures

Additional studies not widely known swing a meta-analysis in a surprising direction, and the results look solid

What’s the Claim?

Thought we’d heard everything that could be said in the ORIF versus arthroplasty wars over the femoral neck? I thought so, too, until a recent meta-analysis looking exclusively at nondisplaced femoral neck fractures found hemiarthroplasty generally superior to internal fixation. Hemi beat cannulated screws by a modest increment on outcomes scores but substantially outperformed it in terms of complications and reoperations (about 1 in 5 patients who had ORIF had a complication or reoperation, compared to only 6% of those in the hemiarthroplasty groups of the three RCTs whose data were pooled in this meta-analysis). Hemiarthroplasty resulted in more blood loss (by about 130 cc, though tranexamic acid probably could mitigate this in real-world practice) and took longer to perform — by nearly 25 minutes on average.

How’s It Stack Up?