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OBJECTIVE: In hemiarthroplasty, the choice of prosthesis is particularly important, which directly affects the success rate of operation and postoperative complications. Hemiarthroplasty can be divided into bipolar hemiarthroplasty and unipolar hemiarthroplasty. This study systematically evaluated the clinical efficacy and safety of bipolar hemiarthroplasty and unipolar hemiarthroplasty in the treatment of displaced femoral neck fractures in the elderly so as to provide evidence-based support for prosthesis decision-making in hemiarthroplasty. METHODS: The databases including PubMed, The Cochrane Library, OVID, Web of Science, Scopus, China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP database were searched to collect clinical randomized controlled trials of bipolar hemiarthroplasty and unipolar hemiarthroplasty for displaced neck femoral neck fractures in elderly patients at home and abroad. The Cochrane Handbook risk assessment tool was used to evaluate the quality of the included studies. The results of the included studies were meta-analyzed by RevMan 5.3 software. RESULTS: (1) Eighteen randomized controlled clinical trials with high quality were included, with a total of 1 988 fractures patients, including 998 cases in bipolar hemiarthroplasty group and 990 cases in unipolar hemiarthroplasty group. (2) There were no statistically significant differences in mortality, dislocation of prosthesis, loosening of prosthesis, local infection, hip pain, general complication, and surgical informations between bipolar hemiarthroplasty and unipolar hemiarthroplasty (P > 0.05). (3) Harris score was higher in the bipolar hemiarthroplasty group than that in the unipolar hemiarthroplasty group (MD=1.77, 95%CI:0.94-2.61, P < 0.001). The rate of acetabular erosion in bipolar hemiarthroplasty group was lower than that in unipolar hemiarthroplasty group (RR=0.25, 95%CI:0.13-0.47, P < 0.000 1). However, two studies have reported that bipolar implants may be more costly. CONCLUSION: Compared with unipolar hemiarthroplasty, bipolar hemiarthroplasty has lower acetabular wear rate and better recovery of hip function in elderly patients with displaced fem-oral neck fracture. However, whether bipolar prosthesis has better economic benefits than uni-polar prosthesis needs further evaluation in the future. [ABSTRACT FROM AUTHOR]

BACKGROUND: Surgical treatment is an accepted method for intertrochanteric fractures. For the older adults accompanied by severe osteoporosis and other diseases, how to treat intertrochanteric fractures still remains controversial. OBJECTIVE: To evaluate the effectiveness and safety of proximal femoral nail antirotation versus hemiarthroplasty in the treatment of unstable intertrochanteric fractures in older adults through meta-analysis. METHODS: According to the Cochrane system evaluation, a computer-based retrieval of Medline, PubMed, SPINGER, John Wiley, Science Direct, EBSCO, CNKI, WanFang, and VIP databases between 2008 and 2018 was performed. The keywords were “proximal femoral nail antirotation or PFNA, hemiarthroplasty, unstable intertrochanteric fractures” in English and Chinese, respectively. The literate was screened based on inclusion and exclusion criteria, and then quality evaluation was conducted. Meta-analysis was undergone on the Rev-Man 5.1 software. RUSULTS AND CONCLUSION: (1) Thirteen clinical trials were included, involving 1 223 patients, and including 6 randomized controlled trials. (2) Meta-analysis results showed that the operation time in the proximal femoral nail antirotation group was shorter [MD=-6.54, 95%Cl (-12.81, -0.21), P < 0.01], intraoperative blood loss was lower [MD=-130.83, 95%CI (-190.99, -70.68), P < 0.01], and the incidence of implant complications was higher [RR=2.32, 95%Cl (1.12, 4.84), P < 0.01] compared with the hemiarthroplasty group. (3) In the hemiarthroplasty group, the ambulation time was earlier [MD=18.06, 95%CI (10.3, 25.79), P < 0.000 1], and the Harris scores were increased [MD=-8.19, 95%Cl (-9.45, -6.93), P < 0.01] compared with the proximal femoral nail antirotation group. (4) There was no significant difference in the postoperative complications, hospitalization time or excellent and good rate in Harris scores between two groups (P > 0.05). (5) In summary, the operation time in the proximal femoral nail antirotation group is shorter and the amount of bleeding was less than those in the hemiarthroplasty group, but the incidence of implant complications is higher than that in the hemiarthroplasty group. The hemiarthroplasty group has an advantage in postoperative Harris score and postoperative loading time. [ABSTRACT FROM AUTHOR]