A Cochrane review [Abstract] 1 included 19 studies with a total of 3 044 subjects. Length of surgery, operative blood loss, need for blood transfusion and risk of deep wound infection were significantly less for internal fixation compared with arthroplasty. Fixation was on average 28 minutes quicker than arthroplasty (95% CI 26.87 to 29.81 minutes; weighted mean difference [WMD] -32.67 minutes, 95% CI -47.89 to -17.46 minutes; 7 studies). Weighted mean difference for operative blood loss favouring fixation was -188.20 ml (95% CI -201.75 to -174.64 ml; 6 studies). Relative risk for the need of transfusion following fixation compared with arthroplasty was 0.19 (95% CI 0.04 to 0.80; 5 studies). Fixation had a significantly higher re-operation rate in comparison with arthroplasty (40% versus 11%; risk ratio 3.22, 95% CI 2.31 to 4.47, 19 trials). No definite differences for hospital stay, mortality, or regain of same residential state were found. Limited information from some studies suggested pain was less and function was better for a cemented arthroplasty in comparison to fixation.
Comment: The quality of evidence is downgraded by limitations in study quality (poor reporting) and by inconsistency (heterogeneity in interventions and outcomes).
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