Scolaris Content Display Scolaris Content Display

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 1

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figures and Tables -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 1 Length of surgery ( in minutes).
Figures and Tables -
Analysis 1.1

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 1 Length of surgery ( in minutes).

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 2 Operative blood loss (in millilitres).
Figures and Tables -
Analysis 1.2

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 2 Operative blood loss (in millilitres).

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 3 Number of patients transfused.
Figures and Tables -
Analysis 1.3

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 3 Number of patients transfused.

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 4 Mean units blood transfused.
Figures and Tables -
Analysis 1.4

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 4 Mean units blood transfused.

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 5 Non‐union of fracture within follow‐up period (includes early displacement).
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Analysis 1.5

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 5 Non‐union of fracture within follow‐up period (includes early displacement).

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 6 Avascular necrosis.
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Analysis 1.6

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 6 Avascular necrosis.

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 7 Dislocation of prosthesis.
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Analysis 1.7

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 7 Dislocation of prosthesis.

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 8 Loosening of prosthesis.
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Analysis 1.8

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 8 Loosening of prosthesis.

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 9 Acetabular wear (as defined by each study).
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Analysis 1.9

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 9 Acetabular wear (as defined by each study).

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 10 Fracture below/around implant.
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Analysis 1.10

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 10 Fracture below/around implant.

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 11 Re‐operations minor (e.g. removal of fixation, dislocation of arthroplasty).
Figures and Tables -
Analysis 1.11

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 11 Re‐operations minor (e.g. removal of fixation, dislocation of arthroplasty).

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 12 Re‐operations moderate (e.g. fixation to arthroplasty, drainage, girdlestone).
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Analysis 1.12

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 12 Re‐operations moderate (e.g. fixation to arthroplasty, drainage, girdlestone).

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 13 Re‐operations major (e.g. revision arthroplasty, hemiarthroplasty to THR).
Figures and Tables -
Analysis 1.13

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 13 Re‐operations major (e.g. revision arthroplasty, hemiarthroplasty to THR).

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 14 Total re‐operation rate (within follow‐up period of study).
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Analysis 1.14

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 14 Total re‐operation rate (within follow‐up period of study).

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 15 Superficial wound infection.
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Analysis 1.15

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 15 Superficial wound infection.

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 16 Deep wound infection.
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Analysis 1.16

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 16 Deep wound infection.

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 17 Pneumonia.
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Analysis 1.17

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 17 Pneumonia.

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 18 Deep vein thrombosis.
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Analysis 1.18

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 18 Deep vein thrombosis.

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 19 Pulmonary embolism.
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Analysis 1.19

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 19 Pulmonary embolism.

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 20 Thromboembolic complications combined.
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Analysis 1.20

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 20 Thromboembolic complications combined.

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 21 Congestive cardiac failure/heart failure.
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Analysis 1.21

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 21 Congestive cardiac failure/heart failure.

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 22 Myocardial infarction.
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Analysis 1.22

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 22 Myocardial infarction.

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 23 Stroke (cerebrovascular accident).
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Analysis 1.23

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 23 Stroke (cerebrovascular accident).

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 24 Confusional state.
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Analysis 1.24

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 24 Confusional state.

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 25 Gastrointestinal complications.
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Analysis 1.25

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 25 Gastrointestinal complications.

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 26 Pressure sores.
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Analysis 1.26

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 26 Pressure sores.

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 27 Total medical complications (as defined in each study).
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Analysis 1.27

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 27 Total medical complications (as defined in each study).

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 28 Length of hospital stay (in days).
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Analysis 1.28

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 28 Length of hospital stay (in days).

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 29 Mortality 30 days.
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Analysis 1.29

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 29 Mortality 30 days.

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 30 Mortality up to 3 to 6 months.
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Analysis 1.30

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 30 Mortality up to 3 to 6 months.

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 31 Mortality up to 12 months.
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Analysis 1.31

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 31 Mortality up to 12 months.

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 32 Mortality up to 24 to 48 months.
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Analysis 1.32

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 32 Mortality up to 24 to 48 months.

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 33 Mortality 10 years.
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Analysis 1.33

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 33 Mortality 10 years.

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 34 Residual pain at 1 year.
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Analysis 1.34

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 34 Residual pain at 1 year.

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 35 Residual pain at 1 year (subgrouped by cemented versus uncemented).
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Analysis 1.35

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 35 Residual pain at 1 year (subgrouped by cemented versus uncemented).

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 36 Mean pain score at 1 to 2 years.
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Analysis 1.36

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 36 Mean pain score at 1 to 2 years.

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 37 Mean pain score at 1 to 2 years (subgrouped by cemented versus uncemented).
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Analysis 1.37

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 37 Mean pain score at 1 to 2 years (subgrouped by cemented versus uncemented).

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 38 Pain at 2 to 3 years.
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Analysis 1.38

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 38 Pain at 2 to 3 years.

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 39 Failure to return to same residence at final follow‐up.
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Analysis 1.39

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 39 Failure to return to same residence at final follow‐up.

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 40 Failure to regain mobility.
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Analysis 1.40

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 40 Failure to regain mobility.

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 41 Harris hip score (at 1 year).
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Analysis 1.41

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 41 Harris hip score (at 1 year).

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 42 Hip rating questionnaire at 1 year.
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Analysis 1.42

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 42 Hip rating questionnaire at 1 year.

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 43 Hip scores (at 1 year).
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Analysis 1.43

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 43 Hip scores (at 1 year).

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 44 Mean Eq‐5d score (at 1 year).
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Analysis 1.44

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 44 Mean Eq‐5d score (at 1 year).

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 45 Barthel index score of below 95 at 1 year.
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Analysis 1.45

Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 45 Barthel index score of below 95 at 1 year.

Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 1 Length of surgery (in minutes).
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Analysis 2.1

Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 1 Length of surgery (in minutes).

Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 2 Operative blood loss (in millilitres).
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Analysis 2.2

Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 2 Operative blood loss (in millilitres).

Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 3 Number of patients transfused.
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Analysis 2.3

Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 3 Number of patients transfused.

Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 4 Re‐operations minor ( eg fixation‐ removal of metalwork, dislocation of hemiarthroplasty).
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Analysis 2.4

Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 4 Re‐operations minor ( eg fixation‐ removal of metalwork, dislocation of hemiarthroplasty).

Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 5 Re‐operations moderate (eg fixation to hemiarthroplasty or total hip replacement, drainage, girdlestone).
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Analysis 2.5

Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 5 Re‐operations moderate (eg fixation to hemiarthroplasty or total hip replacement, drainage, girdlestone).

Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 6 Re‐operations major (eg revision hemiarthroplasty or conversion to total hip replacement).
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Analysis 2.6

Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 6 Re‐operations major (eg revision hemiarthroplasty or conversion to total hip replacement).

Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 7 Total re‐operation rate (within follow‐up period of study).
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Analysis 2.7

Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 7 Total re‐operation rate (within follow‐up period of study).

Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 8 Superficial wound infection.
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Analysis 2.8

Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 8 Superficial wound infection.

Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 9 Deep wound infection.
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Analysis 2.9

Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 9 Deep wound infection.

Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 10 Length of hospital stay (in days).
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Analysis 2.10

Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 10 Length of hospital stay (in days).

Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 11 Mortality at 30 days.
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Analysis 2.11

Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 11 Mortality at 30 days.

Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 12 Mortality up to 3 to 6 months.
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Analysis 2.12

Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 12 Mortality up to 3 to 6 months.

Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 13 Mortality up to 12 months.
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Analysis 2.13

Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 13 Mortality up to 12 months.

Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 14 Mortality 24 to 48 months.
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Analysis 2.14

Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 14 Mortality 24 to 48 months.

Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 15 Mortality 10 years.
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Analysis 2.15

Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 15 Mortality 10 years.

Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 16 Pain at one year.
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Analysis 2.16

Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 16 Pain at one year.

Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 17 Failure to return to same residence at final follow‐up.
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Analysis 2.17

Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 17 Failure to return to same residence at final follow‐up.

Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 18 Failure to regain mobility.
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Analysis 2.18

Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 18 Failure to regain mobility.

Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 1 Length of surgery (in minutes).
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Analysis 3.1

Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 1 Length of surgery (in minutes).

Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 2 Operative blood loss (in millilitres).
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Analysis 3.2

Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 2 Operative blood loss (in millilitres).

Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 3 Number of patients transfused.
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Analysis 3.3

Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 3 Number of patients transfused.

Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 4 Re‐operations minor (Fixation removal of metalwork, dislocation of THR).
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Analysis 3.4

Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 4 Re‐operations minor (Fixation removal of metalwork, dislocation of THR).

Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 5 Re‐operations moderate (Fixation to hemiarthroplasty or THR, drainage, girdlestone).
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Analysis 3.5

Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 5 Re‐operations moderate (Fixation to hemiarthroplasty or THR, drainage, girdlestone).

Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 6 Re‐operations major (revision THR).
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Analysis 3.6

Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 6 Re‐operations major (revision THR).

Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 7 Total re‐operation rate (within follow‐up period of study).
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Analysis 3.7

Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 7 Total re‐operation rate (within follow‐up period of study).

Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 8 Superficial wound infection.
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Analysis 3.8

Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 8 Superficial wound infection.

Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 9 Deep wound infection.
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Analysis 3.9

Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 9 Deep wound infection.

Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 10 Hospital stay (days).
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Analysis 3.10

Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 10 Hospital stay (days).

Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 11 Mortality up to 2 to 4 months.
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Analysis 3.11

Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 11 Mortality up to 2 to 4 months.

Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 12 Mortality at 12 to 18 months.
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Analysis 3.12

Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 12 Mortality at 12 to 18 months.

Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 13 Mortality at 24 months.
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Analysis 3.13

Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 13 Mortality at 24 months.

Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 14 Mortality at 4 years.
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Analysis 3.14

Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 14 Mortality at 4 years.

Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 15 Pain at 1 year.
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Analysis 3.15

Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 15 Pain at 1 year.

Table 1. Methodological quality assessment scheme

1. Was there clear concealment of allocation?

Score 3 if allocation was concealed (e.g. numbered sealed opaque envelopes drawn consecutively). Score 2 if there was a possible chance of disclosure before allocation. Score 1 if the method of allocation concealment or randomisation was not stated or was unclear. Score 0 if allocation concealment was clearly not concealed such as those trials using quasi‐randomisation (e.g. even or odd date of birth).

2. Were the inclusion and exclusion criteria clearly defined?

Score 1 if text states the type of fracture and which patients were included and/or excluded. Otherwise score 0.

3. Were the outcomes of trial participants who withdrew or excluded after allocation described and included in an intention‐to‐treat analysis?

Score 1 if yes or text states that no withdrawals occurred, or data are presented that, by clearly showing 'participant flow', allow this to be inferred. Otherwise score 0.

4. Were the treatment and control groups adequately described at entry and if so were the groups well matched or appropriate co‐variate adjustment made?

Score 1 if at least four admission details given (e.g. age, sex, mobility, function score, mental test score, fracture type) with no significant difference between groups or appropriate adjustment made. Otherwise score 0.

5. Did the surgeons have prior experience of the operations they performed in the trial, prior to its commencement?

Score 1 if text states there was an introductory period or that surgeons were experienced. Otherwise score 0.

6. Were the care programmes other than trial options identical?

Score 1 if text states they were or if this can be inferred. Otherwise score 0.

7. Were the outcome measures clearly defined in the text with a definition of any ambiguous terms encountered?

Score 1 if yes. Otherwise score 0.

8. Were the outcome assessors blind to assignment status?

Score 1 if assessors of pain and function at follow‐up were blinded to treatment outcome. Otherwise score 0.

9. Was the timing of outcome measures appropriate? A minimum of 24 months active follow‐up for all surviving trial participants.

Score 1 if yes. Otherwise score 0.

10. Was loss to follow‐up reported and if so were less than 5% of trial participants lost to follow‐up?

Score 1 if yes. Otherwise score 0.

Figures and Tables -
Table 1. Methodological quality assessment scheme
Table 2. Methodological quality assessment results (see Table 1 for criteria)

Study ID

Item 1

Item 2

Item 3

Item 4

Item 5

Item 6

Item 7

Item 8

Item 9

Item 10

Soreide 1979

0

0

0

0

0

0

1

0

0

0

Jensen 1984

2

0

0

0

0

1

1

0

1

1

Svenningsen 1985

1

0

0

0

0

0

1

0

1

1

Skinner 1989

0

1

0

0

0

0

1

0

0

0

van Vugt 1993

1

1

0

1

0

0

1

0

1

1

Jonsson 1996

2

1

0

0

0

1

1

0

1

1

Neander 1997

1

1

0

0

0

0

1

0

0

1

van Dortmont 2000

2

1

1

1

0

1

1

0

1

1

Davison 2001

2

1

0

1

0

1

0

1

1

0

Puolakka 2001

2

1

0

1

0

0

1

0

1

1

Johansson 2002

1

1

0

0

0

1

1

0

1

0

Parker 2002

2

1

1

1

1

1

0

0

1

1

Rogmark 2002

3

1

0

0

1

1

1

0

1

1

Roden 2003

2

1

0

0

0

0

0

0

1

1

Tidermark 2003

2

1

0

1

1

1

1

0

1

1

Blomfeldt 2005

2

1

1

1

1

1

1

0

1

1

STARS 2006

3

1

1

0

0

0

1

0

1

1

Frihagen 2007

3

1

1

1

0

0

1

1

1

1

Mouzopoulos 2008

0

1

0

1

0

1

1

1

1

0

Figures and Tables -
Table 2. Methodological quality assessment results (see Table 1 for criteria)
Comparison 1. Internal fixation versus arthroplasty (all types)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Length of surgery ( in minutes) Show forest plot

8

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.1 Fixation versus hemiarthroplasty

6

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 Fixation versus total hip replacement

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.3 Internal fixation versus replacement arthroplasty (various)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Operative blood loss (in millilitres) Show forest plot

7

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2.1 Fixation versus hemiarthroplasty

6

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.2 Fixation versus total hip replacement

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Number of patients transfused Show forest plot

6

1231

Risk Ratio (M‐H, Random, 95% CI)

0.24 [0.09, 0.64]

3.1 Fixation versus hemiarthroplasty

4

831

Risk Ratio (M‐H, Random, 95% CI)

0.24 [0.11, 0.53]

3.2 Fixation versus total hip replacement

1

102

Risk Ratio (M‐H, Random, 95% CI)

0.07 [0.02, 0.22]

3.3 Internal fixation versus replacement arthroplasty (various)

1

298

Risk Ratio (M‐H, Random, 95% CI)

1.08 [0.71, 1.63]

4 Mean units blood transfused Show forest plot

2

547

Mean Difference (IV, Random, 95% CI)

‐0.57 [‐1.10, ‐0.04]

4.1 Fixation versus hemiarthroplasty

2

547

Mean Difference (IV, Random, 95% CI)

‐0.57 [‐1.10, ‐0.04]

5 Non‐union of fracture within follow‐up period (includes early displacement) Show forest plot

15

2178

Risk Ratio (M‐H, Fixed, 95% CI)

27.94 [15.65, 49.86]

5.1 Fixation versus hemiarthroplasty

10

1454

Risk Ratio (M‐H, Fixed, 95% CI)

24.24 [12.68, 46.36]

5.2 Fixation versus total hip replacement

4

315

Risk Ratio (M‐H, Fixed, 95% CI)

22.59 [5.52, 92.50]

5.3 Internal fixation versus replacement arthroplasty (various)

1

409

Risk Ratio (M‐H, Fixed, 95% CI)

110.67 [6.89, 1776.91]

6 Avascular necrosis Show forest plot

12

2051

Risk Ratio (M‐H, Fixed, 95% CI)

19.22 [8.16, 45.27]

6.1 Fixation versus hemiarthroplasty

9

1394

Risk Ratio (M‐H, Fixed, 95% CI)

13.06 [4.82, 35.42]

6.2 Fixation versus total hip replacement

2

248

Risk Ratio (M‐H, Fixed, 95% CI)

20.66 [2.83, 150.74]

6.3 Internal fixation versus replacement arthroplasty (various)

1

409

Risk Ratio (M‐H, Fixed, 95% CI)

61.09 [3.77, 989.69]

7 Dislocation of prosthesis Show forest plot

15

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

7.1 Fixation versus hemiarthroplasty

10

1806

Risk Ratio (M‐H, Random, 95% CI)

0.27 [0.06, 1.16]

7.2 Fixation versus total hip replacement

6

806

Risk Ratio (M‐H, Random, 95% CI)

0.08 [0.02, 0.25]

7.3 Internal fixation versus replacement arthroplasty (various)

1

298

Risk Ratio (M‐H, Random, 95% CI)

1.27 [0.40, 4.07]

8 Loosening of prosthesis Show forest plot

6

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

8.1 Fixation versus hemiarthroplasty

6

1185

Risk Ratio (M‐H, Fixed, 95% CI)

0.22 [0.08, 0.61]

8.2 Internal fixation versus total hip replacement

1

320

Risk Ratio (M‐H, Fixed, 95% CI)

0.10 [0.00, 1.97]

9 Acetabular wear (as defined by each study) Show forest plot

5

940

Risk Ratio (M‐H, Fixed, 95% CI)

0.21 [0.05, 0.90]

9.1 Fixation versus hemiarthroplasty

5

940

Risk Ratio (M‐H, Fixed, 95% CI)

0.21 [0.05, 0.90]

10 Fracture below/around implant Show forest plot

5

1128

Risk Ratio (M‐H, Random, 95% CI)

0.40 [0.09, 1.67]

10.1 Fixation versus hemiarthroplasty

3

617

Risk Ratio (M‐H, Random, 95% CI)

0.49 [0.05, 4.56]

10.2 Fixation versus total hip replacement

1

102

Risk Ratio (M‐H, Random, 95% CI)

0.31 [0.01, 7.40]

10.3 Internal fixation versus replacement arthroplasty (various)

1

409

Risk Ratio (M‐H, Random, 95% CI)

0.18 [0.02, 1.50]

11 Re‐operations minor (e.g. removal of fixation, dislocation of arthroplasty) Show forest plot

17

2618

Risk Ratio (M‐H, Random, 95% CI)

1.36 [0.69, 2.68]

11.1 Fixation versus hemiarthroplasty

11

1623

Risk Ratio (M‐H, Random, 95% CI)

2.36 [1.05, 5.30]

11.2 Fixation versus total hip replacement

4

315

Risk Ratio (M‐H, Random, 95% CI)

0.86 [0.16, 4.70]

11.3 Internal fixation versus replacement arthroplasty (various)

2

680

Risk Ratio (M‐H, Random, 95% CI)

0.24 [0.00, 22.30]

12 Re‐operations moderate (e.g. fixation to arthroplasty, drainage, girdlestone) Show forest plot

17

2618

Risk Ratio (M‐H, Random, 95% CI)

9.35 [5.79, 15.07]

12.1 Fixation versus hemiarthroplasty

11

1623

Risk Ratio (M‐H, Random, 95% CI)

7.56 [4.88, 11.72]

12.2 Fixation versus total hip replacement

4

315

Risk Ratio (M‐H, Random, 95% CI)

17.96 [4.31, 74.91]

12.3 Internal fixation versus replacement arthroplasty (various)

2

680

Risk Ratio (M‐H, Random, 95% CI)

45.28 [3.31, 619.46]

13 Re‐operations major (e.g. revision arthroplasty, hemiarthroplasty to THR) Show forest plot

17

2618

Risk Ratio (M‐H, Random, 95% CI)

0.41 [0.19, 0.87]

13.1 Fixation versus hemiarthroplasty

11

1623

Risk Ratio (M‐H, Random, 95% CI)

0.47 [0.16, 1.41]

13.2 Fixation versus total hip replacement

4

315

Risk Ratio (M‐H, Random, 95% CI)

0.24 [0.03, 2.12]

13.3 Internal fixation versus replacement arthroplasty (various)

2

680

Risk Ratio (M‐H, Random, 95% CI)

0.19 [0.01, 4.21]

14 Total re‐operation rate (within follow‐up period of study) Show forest plot

19

3045

Risk Ratio (M‐H, Random, 95% CI)

3.22 [2.31, 4.47]

14.1 Fixation versus hemiarthroplasty

11

1623

Risk Ratio (M‐H, Random, 95% CI)

3.13 [1.95, 5.03]

14.2 Fixation versus total hip replacement

4

315

Risk Ratio (M‐H, Random, 95% CI)

3.43 [1.45, 8.10]

14.3 Internal fixation versus replacement arthroplasty (various)

4

1107

Risk Ratio (M‐H, Random, 95% CI)

3.26 [1.65, 6.43]

15 Superficial wound infection Show forest plot

14

1986

Risk Ratio (M‐H, Fixed, 95% CI)

0.85 [0.53, 1.38]

15.1 Fixation versus hemiarthroplasty

9

1373

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.46, 1.58]

15.2 Fixation versus total hip replacement

4

315

Risk Ratio (M‐H, Fixed, 95% CI)

0.43 [0.13, 1.50]

15.3 Internal fixation versus replacement arthroplasty (various)

1

298

Risk Ratio (M‐H, Fixed, 95% CI)

1.53 [0.50, 4.62]

16 Deep wound infection Show forest plot

15

2825

Risk Ratio (M‐H, Fixed, 95% CI)

0.53 [0.30, 0.93]

16.1 Fixation versus hemiarthroplasty

10

1592

Risk Ratio (M‐H, Fixed, 95% CI)

0.47 [0.24, 0.91]

16.2 Fixation versus total hip replacement

2

248

Risk Ratio (M‐H, Fixed, 95% CI)

2.62 [0.11, 63.28]

16.3 Internal fixation versus replacement arthroplasty (various)

3

985

Risk Ratio (M‐H, Fixed, 95% CI)

0.59 [0.17, 2.07]

17 Pneumonia Show forest plot

5

1003

Risk Ratio (M‐H, Fixed, 95% CI)

0.84 [0.51, 1.40]

17.1 Fixation versus hemiarthroplasty

4

857

Risk Ratio (M‐H, Fixed, 95% CI)

0.95 [0.56, 1.61]

17.2 Fixation versus total hip replacement

1

146

Risk Ratio (M‐H, Fixed, 95% CI)

0.12 [0.01, 2.37]

18 Deep vein thrombosis Show forest plot

9

1558

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.50, 1.96]

18.1 Fixation versus hemiarthroplasty

4

945

Risk Ratio (M‐H, Fixed, 95% CI)

1.41 [0.50, 3.96]

18.2 Fixation versus total hip replacement

4

315

Risk Ratio (M‐H, Fixed, 95% CI)

0.35 [0.08, 1.52]

18.3 Internal fixation versus replacement arthroplasty (various)

1

298

Risk Ratio (M‐H, Fixed, 95% CI)

1.53 [0.39, 5.98]

19 Pulmonary embolism Show forest plot

9

1558

Risk Ratio (M‐H, Fixed, 95% CI)

1.30 [0.59, 2.86]

19.1 Fixation versus hemiarthroplasty

4

945

Risk Ratio (M‐H, Fixed, 95% CI)

1.89 [0.58, 6.15]

19.2 Fixation versus total hip replacement

4

315

Risk Ratio (M‐H, Fixed, 95% CI)

1.92 [0.37, 10.12]

19.3 Internal fixation versus replacement arthroplasty (various)

1

298

Risk Ratio (M‐H, Fixed, 95% CI)

0.51 [0.10, 2.48]

20 Thromboembolic complications combined Show forest plot

13

2174

Risk Ratio (M‐H, Fixed, 95% CI)

1.13 [0.70, 1.83]

20.1 Fixation versus hemiarthroplasty

7

1152

Risk Ratio (M‐H, Fixed, 95% CI)

1.34 [0.67, 2.68]

20.2 Fixation versus total hip replacement

4

315

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.22, 2.06]

20.3 Internal fixation versus replacement arthroplasty (various)

2

707

Risk Ratio (M‐H, Fixed, 95% CI)

1.19 [0.52, 2.72]

21 Congestive cardiac failure/heart failure Show forest plot

4

1057

Risk Ratio (M‐H, Fixed, 95% CI)

0.88 [0.45, 1.70]

21.1 Fixation versus hemiarthroplasty

1

455

Risk Ratio (M‐H, Fixed, 95% CI)

1.01 [0.33, 3.09]

21.2 Fixation versus total hip replacement

2

193

Risk Ratio (M‐H, Fixed, 95% CI)

0.91 [0.16, 5.04]

21.3 Internal fixation versus replacement arthroplasty (various)

1

409

Risk Ratio (M‐H, Fixed, 95% CI)

0.79 [0.31, 2.00]

22 Myocardial infarction Show forest plot

6

1068

Risk Ratio (M‐H, Fixed, 95% CI)

0.58 [0.22, 1.51]

22.1 Fixation versus hemiarthroplasty

1

455

Risk Ratio (M‐H, Fixed, 95% CI)

5.07 [0.24, 104.94]

22.2 Fixation versus total hip replacement

4

315

Risk Ratio (M‐H, Fixed, 95% CI)

0.47 [0.12, 1.82]

22.3 Internal fixation versus replacement arthroplasty (various)

1

298

Risk Ratio (M‐H, Fixed, 95% CI)

0.25 [0.03, 2.08]

23 Stroke (cerebrovascular accident) Show forest plot

9

1645

Risk Ratio (M‐H, Fixed, 95% CI)

0.85 [0.43, 1.69]

23.1 Fixation versus hemiarthroplasty

4

725

Risk Ratio (M‐H, Fixed, 95% CI)

0.84 [0.23, 3.09]

23.2 Fixation versus total hip replacement

3

213

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.20, 4.50]

23.3 Internal fixation versus replacement arthroplasty (various)

2

707

Risk Ratio (M‐H, Fixed, 95% CI)

0.83 [0.32, 2.11]

24 Confusional state Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

24.1 Fixation versus hemiarthroplasty

2

675

Risk Ratio (M‐H, Fixed, 95% CI)

0.88 [0.55, 1.39]

25 Gastrointestinal complications Show forest plot

3

703

Risk Ratio (M‐H, Fixed, 95% CI)

0.54 [0.23, 1.30]

25.1 Hemiarthroplasty

2

557

Risk Ratio (M‐H, Fixed, 95% CI)

0.78 [0.28, 2.13]

25.2 Total hip replacement

1

146

Risk Ratio (M‐H, Fixed, 95% CI)

0.17 [0.02, 1.46]

26 Pressure sores Show forest plot

7

1380

Risk Ratio (M‐H, Fixed, 95% CI)

1.11 [0.55, 2.23]

26.1 Fixation versus hemiarthroplasty

4

819

Risk Ratio (M‐H, Fixed, 95% CI)

1.12 [0.47, 2.66]

26.2 Fixation versus total hip replacement

2

152

Risk Ratio (M‐H, Fixed, 95% CI)

1.45 [0.25, 8.31]

26.3 Internal fixation versus replacement arthroplasty (various)

1

409

Risk Ratio (M‐H, Fixed, 95% CI)

0.88 [0.18, 4.33]

27 Total medical complications (as defined in each study) Show forest plot

13

2173

Risk Ratio (M‐H, Random, 95% CI)

0.73 [0.58, 0.92]

27.1 Fixation versus hemiarthroplasty

7

1151

Risk Ratio (M‐H, Random, 95% CI)

0.72 [0.51, 1.02]

27.2 Fixation versus total hip replacement

4

315

Risk Ratio (M‐H, Random, 95% CI)

0.62 [0.36, 1.06]

27.3 Internal fixation versus replacement arthroplasty (various)

2

707

Risk Ratio (M‐H, Random, 95% CI)

0.79 [0.51, 1.22]

28 Length of hospital stay (in days) Show forest plot

5

Mean Difference (IV, Random, 95% CI)

Subtotals only

28.1 Fixation versus hemiarthroplasty

4

821

Mean Difference (IV, Random, 95% CI)

1.12 [‐3.07, 5.31]

28.2 Fixation versus total hip replacement

1

75

Mean Difference (IV, Random, 95% CI)

4.70 [2.51, 6.89]

28.3 Internal fixation versus replacement arthroplasty (various)

1

298

Mean Difference (IV, Random, 95% CI)

‐0.68 [‐2.43, 1.07]

29 Mortality 30 days Show forest plot

4

780

Risk Ratio (M‐H, Fixed, 95% CI)

0.76 [0.46, 1.24]

29.1 Fixation versus hemiarthroplasty

4

780

Risk Ratio (M‐H, Fixed, 95% CI)

0.76 [0.46, 1.24]

30 Mortality up to 3 to 6 months Show forest plot

15

2320

Risk Ratio (M‐H, Fixed, 95% CI)

0.87 [0.70, 1.08]

30.1 Fixation versus hemiarthroplasty

10

1345

Risk Ratio (M‐H, Fixed, 95% CI)

0.84 [0.66, 1.07]

30.2 Fixation versus total hip replacement

3

268

Risk Ratio (M‐H, Fixed, 95% CI)

2.52 [0.89, 7.14]

30.3 Internal fixation versus replacement arthroplasty (various)

2

707

Risk Ratio (M‐H, Fixed, 95% CI)

0.66 [0.34, 1.27]

31 Mortality up to 12 months Show forest plot

14

2317

Risk Ratio (M‐H, Fixed, 95% CI)

0.95 [0.81, 1.11]

31.1 Fixation versus hemiarthroplasty

8

1213

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.78, 1.13]

31.2 Fixation versus total hip replacement

3

268

Risk Ratio (M‐H, Fixed, 95% CI)

1.18 [0.68, 2.05]

31.3 Internal fixation versus replacement arthroplasty (various)

3

836

Risk Ratio (M‐H, Fixed, 95% CI)

0.89 [0.61, 1.30]

32 Mortality up to 24 to 48 months Show forest plot

15

2335

Risk Ratio (M‐H, Fixed, 95% CI)

0.97 [0.87, 1.09]

32.1 Fixation versus hemiarthroplasty

9

1204

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.84, 1.10]

32.2 Fixation versus total hip replacement

3

295

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.71, 1.53]

32.3 Internal fixation versus replacement arthroplasty (various)

3

836

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.74, 1.29]

33 Mortality 10 years Show forest plot

2

864

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.92, 1.05]

33.1 Fixation versus hemiarthroplasty

1

455

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.90, 1.03]

33.2 Internal fixation versus replacement arthroplasty (various)

1

409

Risk Ratio (M‐H, Fixed, 95% CI)

1.01 [0.90, 1.13]

34 Residual pain at 1 year Show forest plot

5

750

Risk Ratio (M‐H, Random, 95% CI)

1.24 [0.79, 1.94]

34.1 Fixation versus hemiarthroplasty

2

366

Risk Ratio (M‐H, Random, 95% CI)

0.81 [0.62, 1.05]

34.2 Fixation versus total hip replacement

2

128

Risk Ratio (M‐H, Random, 95% CI)

3.08 [0.90, 10.56]

34.3 Internal fixation versus replacement arthroplasty (various)

1

256

Risk Ratio (M‐H, Random, 95% CI)

1.3 [1.05, 1.61]

35 Residual pain at 1 year (subgrouped by cemented versus uncemented) Show forest plot

5

750

Risk Ratio (M‐H, Random, 95% CI)

1.24 [0.79, 1.94]

35.1 Fixation versus cemented (hemi)arthroplasty

3

384

Risk Ratio (M‐H, Random, 95% CI)

1.96 [0.91, 4.23]

35.2 Fixation versus uncemented (hemi)arthroplasty

2

366

Risk Ratio (M‐H, Random, 95% CI)

0.81 [0.62, 1.05]

36 Mean pain score at 1 to 2 years Show forest plot

3

521

Std. Mean Difference (IV, Random, 95% CI)

‐0.21 [‐0.68, 0.26]

36.1 Internal fixation versus hemiarthroplasty

2

437

Std. Mean Difference (IV, Random, 95% CI)

‐0.02 [‐0.43, 0.39]

36.2 Internal fixation versus replacement arthroplasty (various types)

1

84

Std. Mean Difference (IV, Random, 95% CI)

‐0.62 [‐1.06, ‐0.19]

37 Mean pain score at 1 to 2 years (subgrouped by cemented versus uncemented) Show forest plot

3

521

Std. Mean Difference (IV, Random, 95% CI)

‐0.21 [‐0.68, 0.26]

37.1 Internal fixation versus cemented (hemi)arthroplasty

2

197

Std. Mean Difference (IV, Random, 95% CI)

‐0.42 [‐0.78, ‐0.07]

37.2 Internal fixation versus uncemented (hemi)arthroplasty

1

324

Std. Mean Difference (IV, Random, 95% CI)

0.17 [‐0.05, 0.38]

38 Pain at 2 to 3 years Show forest plot

2

322

Risk Ratio (M‐H, Random, 95% CI)

3.49 [0.11, 115.59]

38.1 Fixation versus total hip replacement

2

322

Risk Ratio (M‐H, Random, 95% CI)

3.49 [0.11, 115.59]

39 Failure to return to same residence at final follow‐up Show forest plot

2

372

Risk Ratio (M‐H, Fixed, 95% CI)

0.84 [0.54, 1.33]

39.1 Fixation versus hemiarthroplasty

2

372

Risk Ratio (M‐H, Fixed, 95% CI)

0.84 [0.54, 1.33]

40 Failure to regain mobility Show forest plot

6

593

Risk Ratio (M‐H, Random, 95% CI)

1.02 [0.74, 1.39]

40.1 Fixation versus hemiarthroplasty

6

593

Risk Ratio (M‐H, Random, 95% CI)

1.02 [0.74, 1.39]

41 Harris hip score (at 1 year) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

41.1 Fixation versus hemiarthroplasty

2

223

Mean Difference (IV, Fixed, 95% CI)

‐6.61 [‐9.73, ‐3.49]

41.2 Fixation versus total hip replacement

1

65

Mean Difference (IV, Fixed, 95% CI)

‐10.30 [‐12.78, ‐7.82]

42 Hip rating questionnaire at 1 year Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

42.1 Fixation versus hemiarthroplasty

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

42.2 Fixation versus total hip replacement

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

43 Hip scores (at 1 year) Show forest plot

3

Std. Mean Difference (IV, Fixed, 95% CI)

Subtotals only

43.1 Fixation versus hemiarthroplasty

3

374

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.38 [‐0.58, ‐0.17]

43.2 Fixation versus total hip replacement

2

168

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.77 [‐1.10, ‐0.45]

44 Mean Eq‐5d score (at 1 year) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

44.1 Fixation versus hemiarthroplasty

2

341

Mean Difference (IV, Fixed, 95% CI)

‐0.07 [‐0.14, ‐0.00]

44.2 Fixation versus total hip replacement

1

130

Mean Difference (IV, Fixed, 95% CI)

‐0.12 [‐0.33, 0.09]

45 Barthel index score of below 95 at 1 year Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

45.1 Fixation versus hemiarthroplasty

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 1. Internal fixation versus arthroplasty (all types)
Comparison 2. Internal fixation versus hemiarthroplasty

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Length of surgery (in minutes) Show forest plot

6

Mean Difference (IV, Random, 95% CI)

Totals not selected

1.1 Screws versus Thompson

2

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

1.2 Screws versus Moore

2

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

1.3 Screws or SHS versus bipolar hemiarthroplasty

2

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

2 Operative blood loss (in millilitres) Show forest plot

5

Mean Difference (IV, Random, 95% CI)

Totals not selected

2.1 Screws versus Thompson

2

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

2.2 Screws versus Moore

2

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

2.3 Screws or SHS versus bipolar hemiarthroplasty

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

3 Number of patients transfused Show forest plot

5

1060

Risk Ratio (M‐H, Fixed, 95% CI)

0.39 [0.29, 0.53]

3.1 Screws versus Moore

2

507

Risk Ratio (M‐H, Fixed, 95% CI)

0.12 [0.06, 0.26]

3.2 Screws v Christiansen bipolar

1

104

Risk Ratio (M‐H, Fixed, 95% CI)

0.03 [0.00, 0.45]

3.3 Screws or SHS versus bipolar hemiarthroplasty

2

449

Risk Ratio (M‐H, Fixed, 95% CI)

0.80 [0.56, 1.14]

4 Re‐operations minor ( eg fixation‐ removal of metalwork, dislocation of hemiarthroplasty) Show forest plot

12

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

4.1 Screws versus Thompson

2

91

Risk Ratio (M‐H, Random, 95% CI)

0.31 [0.01, 7.15]

4.2 Screws versus Moore

3

617

Risk Ratio (M‐H, Random, 95% CI)

5.39 [0.23, 126.75]

4.3 SHS versus Moore

1

182

Risk Ratio (M‐H, Random, 95% CI)

0.04 [0.00, 0.67]

4.4 SHS versus Stanmore bipolar

1

43

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4.5 Screws, SHS or nail & plate versus Christiansen bipolar

2

273

Risk Ratio (M‐H, Random, 95% CI)

1.15 [0.04, 31.12]

4.6 SHS versus Thompson or Monk bipolar

1

280

Risk Ratio (M‐H, Random, 95% CI)

4.02 [0.75, 21.56]

4.7 2 von Bahr screws versus Variokopf bipolar hemiarthroplasty

1

100

Risk Ratio (M‐H, Random, 95% CI)

1.06 [0.35, 3.26]

4.8 2 Olmed screws versus bipolar hemiarthroplasty

1

219

Risk Ratio (M‐H, Random, 95% CI)

2.80 [1.31, 5.98]

5 Re‐operations moderate (eg fixation to hemiarthroplasty or total hip replacement, drainage, girdlestone) Show forest plot

12

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

5.1 Screws versus Thompson

2

91

Risk Ratio (M‐H, Random, 95% CI)

6.12 [1.13, 33.22]

5.2 Screws versus Moore

3

617

Risk Ratio (M‐H, Random, 95% CI)

8.15 [2.46, 26.98]

5.3 SHS versus Moore

1

182

Risk Ratio (M‐H, Random, 95% CI)

10.00 [3.16, 31.60]

5.4 SHS versus Stanmore bipolar

1

43

Risk Ratio (M‐H, Random, 95% CI)

3.14 [0.71, 13.87]

5.5 Screws, SHS or nail & plate versus Christiansen bipolar

2

273

Risk Ratio (M‐H, Random, 95% CI)

3.72 [1.28, 10.76]

5.6 SHS versus Thompson or Monk bipolar

1

280

Risk Ratio (M‐H, Random, 95% CI)

17.43 [5.41, 56.09]

5.7 2 von Bahr screws versus Variokopf bipolar hemiarthroplasty

1

100

Risk Ratio (M‐H, Random, 95% CI)

7.39 [2.38, 22.91]

5.8 2 Olmed screws versus bipolar hemiarthroplasty

1

219

Risk Ratio (M‐H, Random, 95% CI)

8.37 [3.45, 20.32]

6 Re‐operations major (eg revision hemiarthroplasty or conversion to total hip replacement) Show forest plot

12

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 Screws versus Thompson

2

91

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.2 Screws versus Moore

3

617

Risk Ratio (M‐H, Fixed, 95% CI)

0.71 [0.32, 1.60]

6.3 SHS versus Moore

1

182

Risk Ratio (M‐H, Fixed, 95% CI)

0.03 [0.00, 0.42]

6.4 SHS versus Stanmore bipolar

1

43

Risk Ratio (M‐H, Fixed, 95% CI)

0.10 [0.01, 1.62]

6.5 Screws, SHS or nail & plate versus Christiansen bipolar

2

273

Risk Ratio (M‐H, Fixed, 95% CI)

0.08 [0.01, 0.52]

6.6 SHS versus Thompson or Monk bipolar

1

280

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.07, 6.36]

6.7 2 von Bahr screws versus Variokopf bipolar hemiarthroplasty

1

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.30 [0.01, 7.10]

6.8 2 Olmed screws versus bipolar hemiarthroplasty

1

219

Risk Ratio (M‐H, Fixed, 95% CI)

8.76 [0.48, 160.76]

7 Total re‐operation rate (within follow‐up period of study) Show forest plot

14

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 Screws versus Thompson

2

91

Risk Ratio (M‐H, Fixed, 95% CI)

5.15 [1.22, 21.68]

7.2 Screws versus Moore

3

617

Risk Ratio (M‐H, Fixed, 95% CI)

5.82 [3.85, 8.79]

7.3 SHS versus Moore

1

182

Risk Ratio (M‐H, Fixed, 95% CI)

1.36 [0.85, 2.18]

7.4 SHS versus Stanmore bipolar

1

43

Risk Ratio (M‐H, Fixed, 95% CI)

0.90 [0.36, 2.23]

7.5 Screws, SHS or nail & plate versus Christiansen bipolar

2

273

Risk Ratio (M‐H, Fixed, 95% CI)

1.33 [0.72, 2.47]

7.6 SHS versus Thompson or Monk bipolar

1

280

Risk Ratio (M‐H, Fixed, 95% CI)

7.04 [3.34, 14.83]

7.7 SHS versus hemiarthroplasty (unknown type)

1

86

Risk Ratio (M‐H, Fixed, 95% CI)

2.4 [0.92, 6.23]

7.8 Screws or SHS versus bipolar hemiarthroplasty

1

229

Risk Ratio (M‐H, Fixed, 95% CI)

7.21 [3.21, 16.22]

7.9 2 von Bahr screws versus Variokopf bipolar hemiarthroplasty

1

100

Risk Ratio (M‐H, Fixed, 95% CI)

3.93 [1.91, 8.07]

7.10 2 Olmed screws versus bipolar hemiarthroplasty

1

219

Risk Ratio (M‐H, Fixed, 95% CI)

4.16 [2.28, 7.58]

8 Superficial wound infection Show forest plot

9

1502

Risk Ratio (M‐H, Fixed, 95% CI)

0.87 [0.50, 1.53]

8.1 Screws versus Thompson

1

60

Risk Ratio (M‐H, Fixed, 95% CI)

0.09 [0.00, 1.48]

8.2 Screws versus Moore

3

617

Risk Ratio (M‐H, Fixed, 95% CI)

1.45 [0.56, 3.77]

8.3 SHS versus Stanmore bipolar

1

43

Risk Ratio (M‐H, Fixed, 95% CI)

0.21 [0.01, 4.11]

8.4 Screws, SHS or nail & plate versus Christiansen bipolar

2

273

Risk Ratio (M‐H, Fixed, 95% CI)

0.49 [0.11, 2.13]

8.5 SHS versus Thompson or Monk bipolar

1

280

Risk Ratio (M‐H, Fixed, 95% CI)

6.0 [0.25, 145.88]

8.6 Screws or SHS versus bipolar hemiarthroplasty

1

229

Risk Ratio (M‐H, Fixed, 95% CI)

1.41 [0.41, 4.87]

9 Deep wound infection Show forest plot

11

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

9.1 Screws versus Thompson

1

60

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

9.2 Screws versus Moore

3

617

Risk Ratio (M‐H, Fixed, 95% CI)

0.17 [0.04, 0.75]

9.3 SHS versus Moore

1

198

Risk Ratio (M‐H, Fixed, 95% CI)

0.15 [0.01, 2.79]

9.4 SHS versus Stanmore bipolar

1

43

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

9.5 Screws, SHS or nail & plate versus Christiansen bipolar

2

273

Risk Ratio (M‐H, Fixed, 95% CI)

0.35 [0.08, 1.66]

9.6 SHS versus Thompson or Monk bipolar

1

280

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.03, 16.21]

9.7 Screws or SHS versus bipolar hemiarthroplasty

2

448

Risk Ratio (M‐H, Fixed, 95% CI)

1.23 [0.48, 3.11]

10 Length of hospital stay (in days) Show forest plot

5

1036

Mean Difference (IV, Random, 95% CI)

0.79 [‐2.13, 3.72]

10.1 Screws versus Thompson

1

60

Mean Difference (IV, Random, 95% CI)

4.5 [‐11.20, 20.20]

10.2 Screws versus Moore

1

455

Mean Difference (IV, Random, 95% CI)

0.30 [‐5.20, 5.80]

10.3 Screws or SHS versus bipolar hemiarthroplasty

2

449

Mean Difference (IV, Random, 95% CI)

‐0.80 [‐2.60, 1.00]

10.4 SHS versus hemiarthroplasty (unknown type)

1

72

Mean Difference (IV, Random, 95% CI)

3.90 [2.45, 5.35]

11 Mortality at 30 days Show forest plot

4

780

Risk Ratio (M‐H, Fixed, 95% CI)

0.76 [0.46, 1.24]

11.1 SHS or screws versus bipolar hemiarthroplasty

4

780

Risk Ratio (M‐H, Fixed, 95% CI)

0.76 [0.46, 1.24]

12 Mortality up to 3 to 6 months Show forest plot

10

1474

Risk Ratio (M‐H, Fixed, 95% CI)

0.81 [0.64, 1.03]

12.1 Screws versus Thompson

2

91

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.52, 2.00]

12.2 Screws versus Moore

3

617

Risk Ratio (M‐H, Fixed, 95% CI)

0.77 [0.56, 1.08]

12.3 SHS versus Stanmore bipolar

1

42

Risk Ratio (M‐H, Fixed, 95% CI)

0.25 [0.03, 2.05]

12.4 Screws, SHS or nail & plate versus Christiansen bipolar

2

273

Risk Ratio (M‐H, Fixed, 95% CI)

1.12 [0.61, 2.08]

12.5 Screws or SHS versus bipolar hemiarthroplasty

2

451

Risk Ratio (M‐H, Fixed, 95% CI)

0.71 [0.41, 1.23]

13 Mortality up to 12 months Show forest plot

10

1528

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.78, 1.11]

13.1 Screws versus Thompson

1

60

Risk Ratio (M‐H, Fixed, 95% CI)

1.34 [0.85, 2.11]

13.2 Screws versus Moore

3

617

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.73, 1.21]

13.3 SHS versus Stanmore bipolar

1

41

Risk Ratio (M‐H, Fixed, 95% CI)

0.42 [0.09, 1.92]

13.4 Screws, SHS or nail & plate versus Christiansen bipolar

2

273

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.60, 1.54]

13.5 Screws or SHS versus bipolar hemiarthroplasty

2

451

Risk Ratio (M‐H, Fixed, 95% CI)

0.82 [0.55, 1.24]

13.6 SHS versus hemiarthroplasty (unknown type)

1

86

Risk Ratio (M‐H, Fixed, 95% CI)

0.83 [0.27, 2.53]

14 Mortality 24 to 48 months Show forest plot

11

1519

Risk Ratio (M‐H, Fixed, 95% CI)

0.95 [0.84, 1.08]

14.1 Screws versus Thompson

2

91

Risk Ratio (M‐H, Fixed, 95% CI)

1.16 [0.91, 1.49]

14.2 Screws versus Moore

3

580

Risk Ratio (M‐H, Fixed, 95% CI)

0.88 [0.73, 1.06]

14.3 2 von Bahr screws versus Variokopf bipolar hemiarthroplasty

1

100

Risk Ratio (M‐H, Fixed, 95% CI)

1.55 [0.48, 4.97]

14.4 SHS versus Stanmore bipolar

1

42

Risk Ratio (M‐H, Fixed, 95% CI)

0.83 [0.30, 2.31]

14.5 SHS or nail & plate versus Christiansen bipolar

1

169

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.67, 1.56]

14.6 Screws or SHS versus bipolar hemiarthroplasty

2

451

Risk Ratio (M‐H, Fixed, 95% CI)

0.97 [0.71, 1.32]

14.7 SHS versus hemiarthroplasty (unknown type)

1

86

Risk Ratio (M‐H, Fixed, 95% CI)

0.85 [0.43, 1.67]

15 Mortality 10 years Show forest plot

1

455

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.90, 1.03]

15.1 Screws versus Moore

1

455

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.90, 1.03]

16 Pain at one year Show forest plot

3

561

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.82, 1.18]

16.1 Screws versus Thompson

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

16.2 Screws versus Moore

2

366

Risk Ratio (M‐H, Fixed, 95% CI)

0.80 [0.62, 1.04]

16.3 Screws or SHS versus bipolar hemiarthroplasty

1

195

Risk Ratio (M‐H, Fixed, 95% CI)

1.26 [0.99, 1.61]

17 Failure to return to same residence at final follow‐up Show forest plot

2

372

Risk Ratio (M‐H, Fixed, 95% CI)

0.84 [0.54, 1.33]

17.1 Screws versus Moore

2

372

Risk Ratio (M‐H, Fixed, 95% CI)

0.84 [0.54, 1.33]

18 Failure to regain mobility Show forest plot

6

593

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.86, 1.15]

18.1 Screws versus Thompson

1

24

Risk Ratio (M‐H, Fixed, 95% CI)

1.87 [0.53, 6.57]

18.2 Screws versus Moore

3

419

Risk Ratio (M‐H, Fixed, 95% CI)

0.88 [0.75, 1.04]

18.3 2 von Bahr screws versus Variokopf bipolar hemiarthroplasty

1

84

Risk Ratio (M‐H, Fixed, 95% CI)

1.95 [1.15, 3.30]

18.4 Screws v Christiansen bipolar

1

66

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.69, 1.43]

Figures and Tables -
Comparison 2. Internal fixation versus hemiarthroplasty
Comparison 3. Internal fixation versus Total Hip Replacement

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Length of surgery (in minutes) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.1 2 Olmed screws verus Exeter THR

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 Screws or SHS versus THR (various)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Operative blood loss (in millilitres) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2.1 2 Olmed screws verus Exeter THR

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Number of patients transfused Show forest plot

2

240

Risk Ratio (M‐H, Fixed, 95% CI)

0.32 [0.20, 0.50]

3.1 2 Olmed screws verus Exeter THR

1

102

Risk Ratio (M‐H, Fixed, 95% CI)

0.07 [0.02, 0.22]

3.2 Screws or SHS versus THR (various)

1

138

Risk Ratio (M‐H, Fixed, 95% CI)

0.74 [0.43, 1.26]

4 Re‐operations minor (Fixation removal of metalwork, dislocation of THR) Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 Hansson pin versus Charnley

1

47

Risk Ratio (M‐H, Fixed, 95% CI)

0.19 [0.01, 3.80]

4.2 2 Olmed screws versus Lubinus or BiMetric

2

166

Risk Ratio (M‐H, Fixed, 95% CI)

0.52 [0.23, 1.14]

4.3 2 Olmed screws verus Exeter THR

1

102

Risk Ratio (M‐H, Fixed, 95% CI)

9.25 [1.23, 69.60]

4.4 SHS versus Howse II

1

180

Risk Ratio (M‐H, Fixed, 95% CI)

0.03 [0.00, 0.43]

5 Re‐operations moderate (Fixation to hemiarthroplasty or THR, drainage, girdlestone) Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 Hansson pin versus Charnley

1

47

Risk Ratio (M‐H, Fixed, 95% CI)

14.4 [0.87, 238.56]

5.2 2 Olmed screws versus Lubinus or BiMetric

2

166

Risk Ratio (M‐H, Fixed, 95% CI)

27.16 [3.66, 201.50]

5.3 2 Olmed screws verus Exeter THR

1

102

Risk Ratio (M‐H, Fixed, 95% CI)

34.26 [2.12, 553.64]

5.4 SHS versus Howse II

1

180

Risk Ratio (M‐H, Fixed, 95% CI)

59.67 [3.70, 961.20]

6 Re‐operations major (revision THR) Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 Hannson pin versus Charnley

1

47

Risk Ratio (M‐H, Fixed, 95% CI)

0.32 [0.01, 7.48]

6.2 2 Olmed screws versus Lubinus or BiMetric

2

166

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.3 2 Olmed screws verus Exeter THR

1

102

Risk Ratio (M‐H, Fixed, 95% CI)

0.19 [0.01, 3.76]

6.4 SHS versus Howse II

1

180

Risk Ratio (M‐H, Fixed, 95% CI)

0.08 [0.00, 1.32]

7 Total re‐operation rate (within follow‐up period of study) Show forest plot

7

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 Hansson pin versus Charnley

1

47

Risk Ratio (M‐H, Fixed, 95% CI)

3.35 [0.78, 14.50]

7.2 2 Olmed screws versus Lubinus or Bimetric

2

166

Risk Ratio (M‐H, Fixed, 95% CI)

2.32 [1.36, 3.94]

7.3 2 Olmed screws verus Exeter THR

1

102

Risk Ratio (M‐H, Fixed, 95% CI)

11.56 [2.89, 46.25]

7.4 SHS versus Howse II

1

180

Risk Ratio (M‐H, Fixed, 95% CI)

1.47 [0.90, 2.38]

7.5 Screws or SHS versus THR (various)

1

138

Risk Ratio (M‐H, Fixed, 95% CI)

4.5 [1.98, 10.21]

7.6 SHS versus THR (unknown type)

1

86

Risk Ratio (M‐H, Fixed, 95% CI)

12.0 [1.63, 88.29]

8 Superficial wound infection Show forest plot

4

315

Risk Ratio (M‐H, Fixed, 95% CI)

0.43 [0.13, 1.50]

8.1 Hansson pin versus Charnley

1

47

Risk Ratio (M‐H, Fixed, 95% CI)

0.32 [0.01, 7.48]

8.2 2 Olmed screws versus Lubinus or BiMetric

2

166

Risk Ratio (M‐H, Fixed, 95% CI)

0.66 [0.14, 3.15]

8.3 2 Olmed screws verus Exeter THR

1

102

Risk Ratio (M‐H, Fixed, 95% CI)

0.19 [0.01, 3.76]

9 Deep wound infection Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

9.1 SHS versus Howse II

1

178

Risk Ratio (M‐H, Fixed, 95% CI)

0.16 [0.01, 3.36]

9.2 2 Olmed screws versus Lubinus or BiMetric

1

146

Risk Ratio (M‐H, Fixed, 95% CI)

2.62 [0.11, 63.28]

9.3 2 Olmed screws verus Exeter THR

1

102

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

10 Hospital stay (days) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

10.1 Screws or SHS versus THR (various)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

10.2 SHS versus THR (unknown type)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

11 Mortality up to 2 to 4 months Show forest plot

4

406

Risk Ratio (M‐H, Fixed, 95% CI)

2.21 [0.91, 5.40]

11.1 2 Olmed screws versus Lubinus or BiMetric

2

166

Risk Ratio (M‐H, Fixed, 95% CI)

2.03 [0.65, 6.29]

11.2 2 Olmed screws verus Exeter THR

1

102

Risk Ratio (M‐H, Fixed, 95% CI)

6.48 [0.34, 122.37]

11.3 Screws or SHS versus THR (various)

1

138

Risk Ratio (M‐H, Fixed, 95% CI)

1.5 [0.26, 8.70]

12 Mortality at 12 to 18 months Show forest plot

4

390

Risk Ratio (M‐H, Fixed, 95% CI)

1.03 [0.64, 1.64]

12.1 2 Olmed screws versus Lubinus or BiMetric

2

166

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.55, 1.76]

12.2 Screws or SHS versus THR (various)

1

138

Risk Ratio (M‐H, Fixed, 95% CI)

1.5 [0.44, 5.08]

12.3 SHS versus THR (unknown type)

1

86

Risk Ratio (M‐H, Fixed, 95% CI)

0.83 [0.27, 2.53]

13 Mortality at 24 months Show forest plot

4

433

Risk Ratio (M‐H, Fixed, 95% CI)

1.18 [0.79, 1.75]

13.1 Hansson pin versus Charnley

1

47

Risk Ratio (M‐H, Fixed, 95% CI)

0.64 [0.12, 3.48]

13.2 2 Olmed screws versus Lubinus or BiMetric

1

146

Risk Ratio (M‐H, Fixed, 95% CI)

1.00 [0.61, 1.66]

13.3 2 Olmed screws verus Exeter THR

1

102

Risk Ratio (M‐H, Fixed, 95% CI)

1.85 [0.68, 5.03]

13.4 Screws or SHS versus THR (various)

1

138

Risk Ratio (M‐H, Fixed, 95% CI)

1.5 [0.56, 3.99]

14 Mortality at 4 years Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

14.1 SHS versus THR (unknown type)

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

15 Pain at 1 year Show forest plot

2

157

Risk Ratio (M‐H, Fixed, 95% CI)

1.40 [1.02, 1.90]

15.1 Hansson pin versus Charnley

1

35

Risk Ratio (M‐H, Fixed, 95% CI)

1.91 [0.80, 4.55]

15.2 Screws or SHS versus THR (various)

1

122

Risk Ratio (M‐H, Fixed, 95% CI)

1.31 [0.94, 1.82]

Figures and Tables -
Comparison 3. Internal fixation versus Total Hip Replacement