Replacement arthroplasty versus internal fixation for extracapsular hip fractures (Cochrane Review)

A substantive amendment to this systematic review was last made on 06 February 1997. Cochrane reviews are regularly checked and updated if necessary.

Background: Internal fixation, commonly used for extracapsular hip fractures, may fail particularly in unstable fractures. Replacement of the hip using arthroplasty, often used for intracapsular fractures, has been used as an alternative.

Objectives: To compare replacement arthroplasty with internal fixation for the treatment of extracapsular hip fractures in adults.

Search strategy: We searched the Cochrane Musculoskeletal Injuries Group's trials register and bibliographies of published papers, and contacted colleagues. Date of the most recent search: July 2001.

Selection criteria: Randomised and quasi-randomised trials comparing replacement arthroplasty with an internal fixation implant for skeletally mature patients with an extracapsular hip fracture.

Data collection and analysis: Both reviewers independently assessed trial quality, using a ten item scale, and extracted data. Additional information was sought from trialists. Relative risks and 95 per cent confidence intervals were calculated for relevant dichotomous outcomes and presented graphically.

Main results: Only one randomised trial of 90 patients with unstable extracapsular hip femoral fractures in the trochanteric region was identified and included in this review. This compared arthroplasty with a sliding hip screw and was of poor methodological quality. From the limited data available for this trial, there were no significant differences between the two methods of treatment for operating time, local wound complications, mortality rate or mobility or loss of independence of previously independent patients. There was however a higher blood transfusion need in the arthroplasty group.

Reviewers' conclusions: There is insufficient evidence from randomised trials to determine whether replacement arthroplasty has any advantage over the sliding hip screw for extracapsular hip fractures. Further well designed randomised trials for the treatment of these fractures for this comparison are required.

Citation: Parker MJ, Handoll HHG. Replacement arthroplasty versus internal fixation for extracapsular hip fractures (Cochrane Review). In: The Cochrane Library, Issue 3, 2003. Oxford: Update Software.

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This is an abstract of a regularly updated, systematic review prepared and maintained by the Cochrane Collaboration. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).

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