Outcome of total hip arthroplasty versus hip hemiarthroplasty for femoral neck fractures in the elderly: a meta-analysis of randomized control trial

Background: Roughly 50% of all hip fractures are femoral neck fractures, these fractures are subtype of intracapsular hip fractures. Elderly patient's femoral neck fracture is typically the consequence of a straightforward fall from standing height with low energy. Total hip arthroplasty (THA) versus hip hemiarthroplasty (HHA) is a topic of controversy that sparked discussions over half century ago, between these two types technique have own advantages and disadvantages. Methods: A comprehensive search conducted across major electronic databases for relevant studies published from 2014-2024. Studies THA with HA for elderly patients with femoral neck fractures were included. Data regarding study characteristics, surgical techniques, outcomes, and garden classification were extracted and analyzed using appropriate statistical methods. Our primary outcomes were surgical duration, functional outcome and complications. Results: The initial search yielded total 825 studies, which 7 studies met the inclusion criteria, consisting of total 747 patients THA and HA for elderly patients with femoral neck fractures. THA had longer surgery duration compared with HA (MD=32.48, 95% CI:5.13 to 59.83, p=0.02). THA showed better ratings Harris hip score (HHS) during a year follow-up periods (MD=2.31, 95 CI:0.42 to 4.21, p=0.02). There was no significant difference in complications. Conclusions: THA advantageous over hemiarthroplasty in the terms of HHS but HA favoured in surgical duration. Ultimately, only large well-conducted studies will result in improvements in the outcomes of treatment and resolve the longstanding controversy of whether THA or HA is the preferred treatment modality for femoral neck fracture in elderly.