Total arthroplasty and hemiarthroplasty in the treatment of hip fractures: a systematic review with meta-analysis

Аннотация

Objective: To analyze the effectiveness of hemiarthroplasty compared to total arthroplasty in the treatment of hip fractures. Methodology: Systematic literature review, with a quantitative and qualitative approach to the data collected, which was structured according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA): “total hip arthroplasty” and ‘hemiarthroplasty’ with ‘AND’ and ‘OR’ combinations. Results: The five articles selected evaluated the The American Journal of Medical Sciences and Pharmaceutical Research 6 https://www.theamericanjournals.com/index.php/tajmspr The American Journal of Medical Sciences and Pharmaceutical Research effectiveness of hemiarthroplasty and total hip structured according to the guidelines of the Preferred arthroplasty techniques using the WOMAC score, Reporting Items for Systematic Reviews and Meta- Harris Hip Score (HHS), SF-36 (Short Form Health Analyses (PRISMA), and a checklist was then structured Survey 36) and/or Visual analogue scale (VAS). Total to analyze the results. We considered: 1) framing the arthroplasty showed better results in most studies questions for a literature review; 2) identifying relevant (p<0.01). Conclusion: Total research; 3) assessing the quality of the studies; 4) summarizing the evidence; 5) interpreting the results. arthroplasty was considered the procedure of choice, especially for active elderly patients. The search for studies that met the established criteria took place in June 2024 in databases linked to the Medical Literature Analysis and Retrieval System Online Keywords: Arthroplasty Replacement Hip; (MEDLINE), using the SPICE strategy to identify the Hemiarthroplasty; Hip Fractures. relevant studies: - Scenario: patients with hip fracture. Introduction: The impact of a hip fracture is life- - Perspective: individuals with proximal femur fracture. threatening, with extensive health complications due - Intervention: Surgical correction. to reduced quality of life as a result of potential thrombotic events and loss of function. Fractures of - Comparison: Ability to walk, improvement in quality of the proximal femur, which are more prevalent in the life and biomechanical function. elderly, include the therapeutic options of - Result: Total hip arthroplasty was more effective than hemiarthroplasty or total hip arthroplasty. Both hemiarthroplasty. involve the replacement of the femoral head with a - Study design: Randomized controlled trials, prosthesis or the combined replacement of the counterbalanced crossovers. femoral head and acetabulum with prostheses1. Database search method From April to June 2024, The literature shows the benefits of total implantation records were analyzed from 3 electronic databases in terms of patient function and quality of life (Pubmed, Biblioteca Virtual da Saúde BVS, Ebsco compared to hemiarthroplasty. However, it is known Sportdiscus). The keywords were obtained using the that there is an increased risk of dislocation, greater PubMed "mesh terms" query. The search was caution immediately post-surgery, leading to the conducted with the English terms for: TOTAL possibility of re-approach to reduce or revise the ARTROPLASTY OR HEMIARTROPLASTY with a prosthesis. However, meta-analyses of recent studies combination of "AND" and "OR". involving patients with deviated hip fractures suggest that total hip arthroplasty results in fewer reoperations The studies were then screened according to their and substantially better function than subject matter, restricting them to studies that dealt hemiarthroplasty, taking into account with the surgical correction of proximal femoral physiotherapeutic management and mobility fractures. appropriate to the procedure performed2,3. The inclusion criteria were: studies comparing the Previous studies have shown that in general there techniques of total hip arthroplasty and were fewer complications with total hip arthropathy hemiarthroplasty in the treatment of femoral neck than with hemiarthroplasty. Because of this, some fractures; studies published up to 15 years ago; studies health guidelines recommend this surgery for patients with a population over 50 years old. We excluded animal with displaced femoral neck fractures, which is studies; non-original studies; studies reporting associated with significantly better function over 24 treatments for fractures of other segments of the months4. femur; studies published more than 15 years ago; studies with young patients. Among the options for correcting deviated femoral neck fractures, articles have shown that hip This systematic review was registered in PRÓSPERO arthroplasty has better benefits and quality of life for under ID patients compared to hemiarthroplasty4,5. The aim of CRD42024572129. this study was therefore to analyze the efficacy of