A Cochrane review [Abstract] 1 included 2 studies with a total of 148 subjects aged 70 years or over with unstable extracapsular hip fractures in the trochanteric region. Both had methodological limitations, including inadequate assessment of longer-term outcome. In comparison of cemented arthroplasty with a sliding hip screw, there was no significant differences 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. In comparison of cementless arthroplasty with a proximal femoral nail, there also was 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. In the pooled outcome data, the relative risk (RR) for participants in the arthroplasty group to require blood transfusion was 1.71 (95% CI 1.05 to 2.77) as compared with internal fixation.
Comment: The quality of evidence is downgraded by limitations in study quality, by imprecise results (limited study size for each comparison) and by indirectness (no adequate account of long-term outcomes).
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