Replacement arthroplasty versus internal fixation for extracapsular hip fractures in adults

  • Review
  • Intervention


  • Martyn J Parker,

    Corresponding author
    1. Peterborough and Stamford Hospitals NHS Foundation Trust, Orthopaedic Department, Peterborough, Cambridgeshire, UK
    • Martyn J Parker, Orthopaedic Department, Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough District Hospital, Thorpe Road, Peterborough, Cambridgeshire, PE3 6DA, UK.

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  • Helen HG Handoll

    1. University of Teesside, Centre for Rehabilitation Sciences (CRS), Research Institute for Health Sciences and Social Care, Middlesborough, Tees Valley, UK
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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.


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

Search methods

We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (December 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2005), MEDLINE, EMBASE, the UK National Research Register, several orthopaedic journals, conference proceedings and reference lists of articles.

Selection criteria

Randomised and quasi-randomised trials comparing replacement arthroplasty with an internal fixation implant for adults with an extracapsular hip fracture.

Data collection and analysis

Both review authors independently assessed 10 aspects of trial quality and extracted data. We requested additional information from trial investigators. Where appropriate, limited pooling of data was performed.

Main results

Two randomised controlled trials including a total of 148 people aged 70 years or over with unstable extracapsular hip fractures in the trochanteric region were identified and included in this review. Both had methodological limitations, including inadequate assessment of longer-term outcome. One trial compared a cemented arthroplasty with a sliding hip screw. This found no significant differences between the two methods of treatment for operating time, local wound complications, mechanical complications, reoperation, mortality or loss of independence of previously independent patients at one year. There was, however, a higher blood transfusion need in the arthroplasty group. The other trial compared a cementless arthroplasty versus a proximal femoral nail. It also found a higher blood transfusion need in the arthroplasty group, together with a greater operative blood loss, and a longer length of surgery. There were no significant differences between the two interventions for mechanical complications, local wound complications, reoperation, general complications, mortality at one year or long-term function. None of the pooled outcome data yielded statistically significant differences between the arthroplasty and internal fixation, with the exception of the significantly higher numbers of participants in the arthroplasty group requiring blood transfusion (relative risk 1.71, 95% confidence interval 1.05 to 2.77).

Authors' conclusions

There is insufficient evidence from randomised trials to determine whether replacement arthroplasty has any advantage over internal fixation for extracapsular hip fractures. Further larger well-designed randomised trials comparing arthroplasty versus internal fixation for the treatment of unstable fractures are required.








我們搜尋Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (2005 – 12月), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2005), MEDLINE, EMBASE, the UK National Research Register,數種骨科論文雜誌,研討會及相關文章.


以Randomised and quasirandomised trials來比較成人髖關節囊外骨折採用髖關節置換整形手術與內固定手術




這兩個隨機對照試驗共包括148名70歲或以上的髖關節囊外不穩定股骨粗隆部骨折的病人.這兩個試驗皆有方法方面的限制,包括缺乏評估長期結果。一個試驗比較cemented arthroplasty與sliding hip screw。這兩種治療方法對於開刀時間、局部傷口併發症、機械性併發症、再次手術、死亡或先前能獨立生活的病人在一年後喪失獨立生活的能力,沒有發現顯著的差異。不過,在關節置換術組有較高的輸血需要。另1試驗比較了骨水泥關節置換術(cementless arthroplasty)與股骨近端髓內釘(proximal femoral nail)。研究也發現在關節置換術組有較高的輸血需要、更多的手術失血,及較長的手術時間。兩種的介入治療對於機械性併發症、局部傷口併發症、局部傷口併發症、再次手術、全身併發症、1年死亡率、長期的功能並沒有顯著的差異。匯集的數據並無法在關節置換術組和內固定組之間顯示顯著的差異,唯一的例外是較多的關節置換者需要輸血(relative risk 1.71, 95% confidence interval 1.05 to 2.77).





此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。










Cochrane Bone, Joint and Muscle Trauma Group Specialised Register(2005年12月)、Cochrane Central Register of Controlled Trials(コクラン・ライブラリ2005年4号)、MEDLINE、EMBASE、UK National Research Register、整形外科関連雑誌の数誌、学会抄録および論文の引用文献リストを検索した。










監  訳: 2006.7.10

実施組織: 厚生労働省委託事業によりMindsが実施した。

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Plain language summary

Partial or total hip replacement compared with fracture fixation for treating hip fractures located outside the hip joint

Roughly half of all hip fractures are outside the hip joint capsule (extracapsular proximal femoral fractures). Most of these will be fixed or stabilised using metal implants which are a combination of screws, rods and plates attached to the thigh bone (femur). Occasionally these may fail, particularly in unstable fractures. Replacement of part or all of the hip joint by moulded metal, or metal and plastic, devices (arthroplasty) has been proposed and used as an alternative.

The two randomised controlled trials included in this review tested arthroplasty versus internal fixation in a total of 148 mainly female and older participants. Both trials had methodological flaws that may affect the validity of their results and there was a general lack of evidence on long-term effects. One of the trials found a longer length of surgery for the arthroplasty and both trials found an increased need for blood transfusion for the arthroplasty. Pooled data from the two trials showed no statistically significant differences between the two procedures for reoperations, wound healing complications or mortality at one year. Neither trial found a significant difference in longer-term function.

Overall, the evidence from the two small trials comparing these two approaches for treating extracapsular hip fractures was too limited to make any definite conclusions as to which is better.

Laienverständliche Zusammenfassung

Partieller oder vollständiger Ersatz des Hüftgelenk verglichen mit Fixierung des Bruchs bei Brüchen außerhalb des Hüftgelenks

Ungefähr die Hälfte aller Schenkelhalsbrüche liegen außerhalb der Gelenkkapsel (sog. extrakapsuläre proximale Schenkelhalsfraktur). Meistens werden sie durch Metallimplantate (Schrauben, Nägel, Platten) im oder auf dem Oberschenkelknochen fixiert oder stabilisiert. Manchmal halten diese Implantate nicht, besonders bei instabilen Brüchen. Eine andere Möglichkeit ist, das Hüftgelenk ganz oder teilweise durch eine geformte Metallprothese oder eine kombinierte Metall-Plastik-Prothese zu ersetzen (sog. Arthroplastik).

Es wurden zwei randomisierten kontrollierte Studien eingeschlossen, die Arthroplastik mit interner Fixierung bei insgesamt 148 (vorwiegend weiblichen und älteren) Teilnehmern verglichen. Beide Studien wiesen methodische Fehler auf, die die Validität der Ergebnisse beeinflussen könnten. Außerdem gab es keine Evidenz für die Langzeitwirkung. Eine der Studien stellte eine längere Operationsdauer bei Arthoplastik fest und beide Studien zeigten auf, dass der Bedarf an Bluttransfusionen bei Arthroplastik höher war. Wenn Daten aus den beiden Studien kombiniert wurden, wurde kein statistisch signifikanter Unterschied zwischen beiden Eingriffen gefunden bezüglich nochmaliger Operationen, Wundheilungsstörungen oder der Sterblichkeit im ersten Jahr. Keine der beiden Studien stellte einen signifikanten Unterschied in der langfristigen Funktionsfähigkeit fest.

Zusammenfassend lässt sich sagen, dass die Evidenz aufgrund der beiden kleinen Studien nicht ausreicht, um zu entscheiden, welche dieser beiden Vorgehensweisen bei Schenkelhalsbrüchen außerhalb der Hüftgelenkskapsel besser geeignet ist.

Anmerkungen zur Übersetzung

Koordination durch Cochrane Schweiz