Internal fixation versus arthroplasty for intracapsular proximal femoral fractures in adults

Martyn J Parker; Kurinchi Selvan Gurusamy

doi:10.1002/14651858.CD001708.pub2

Fijación interna versus artroplastia para las fracturas intracapsulares del extremo proximal del fémur en adultos

Contraer todo Desplegar todo

Referencias

Referencias de los estudios incluidos en esta revisión

Ir a:

estudios excluidos
otras referencias
otras versiones publicadas

Blomfeldt R, Tornkvist H, Ponzer S, Soderqvist A, Tidermark J. Internal fixation versus hemiarthroplasty for displaced fractures of the femoral neck in elderly patients with severe cognitive impairment. Journal of Bone and Joint Surgery ‐ British Volume 2005;87(4):523‐9.

Errata in ‐ Blomfeldt R, Tornkvist H, Ponzer S, Soderqvist A, Tidermark J. Internal fixation versus hemiarthroplasty for displaced fractures of the femoral neck in elderly patients with severe cognitive impairment. Journal of Bone & Joint Surgery ‐ British Volume 2005;87(8):1166.

Google Scholar

Tidermark J, Blomfeldt R, Ponzer S, Tornkvist H. Internal fixation versus hemiarthroplasty for displaced femoral neck fractures in elderly patients with severe cognitive impairment: a randomized controlled trial [Abstract]. Orthopaedic Trauma Association Annual Meeting; 2004 Oct 8‐10; Hollywood, Florida. 2004. http://www.hwbf.org/ota/am/ota04/otapa/OTA041056.htm (accessed 24 Jan 2004).

Calder SJ, Anderson GH, Gregg PJ. Bipolar hemiarthroplasty for displaced intracapsular hip fractures: a randomised prospective trial [Abstract]. Journal of Bone and Joint Surgery ‐ British Volume 1995;77 Suppl 2:214.

Google Scholar

Calder SJ, Anderson GH, Harper WM, Gregg PJ. The place of bipolar hemiarthroplasty in displaced intracapsular hip fracture [Abstract]. Journal of Bone and Joint Surgery. British Volume 1995;77 Suppl 1:6.

Google Scholar

Calder SJ, Anderson GH, Harper WM, Gregg PJ. The use of bipolar hemi‐arthroplasty in intracapsular hip fracture ‐ a prospective randomised trial [Abstract]. Journal of Bone and Joint Surgery ‐ British Volume 1995;77 Suppl 1:103.

Google Scholar

Calder SJ, Anderson GH, Harper WM, Gregg PJ. The use of the Nottingham Health Profile in a randomised trial of treatment of displaced intracapsular hip fractures [Abstract]. Journal of Bone and Joint Surgery ‐ British Volume 1994;76 Suppl 2 & 3:150.

Google Scholar

Calder SJ, Anderson GH, Harper WM, Jagger C, Gregg PJ. A subjective health indicator for follow‐up. A randomised trial after treatment of displaced intracapsular hip fractures. Journal of Bone and Joint Surgery ‐ British Volume 1995;77(3):494‐6.

Davison J, Harper WM, Gregg PJ. Which treatment for the displaced fractures of the femoral neck? A prospective randomised comparison of three surgical procedures [Abstract]. Journal of Bone and Joint Surgery ‐ British Volume 1997;79 Suppl 2:243‐4.

Google Scholar

Davison JN, Calder SJ, Anderson GH, Ward G, Jagger C, Harper WM, Gregg PJ. Treatment for displaced intracapsular fracture of the proximal femur: a prospective, randomised trial in patients aged 65 to 79 years. Journal of Bone and Joint Surgery ‐ British Volume 2001;83(2):206‐12.

Davison JNS, Harper WM, Gregg PJ. Treatment for displaced intracapsular fracture of the proximal femur. A prospective randomised trial in patients aged from 65 to 79 years [Abstract]. Journal of Bone and Joint Surgery ‐ British Volume 1999;81 Suppl 2:232.

Google Scholar

Frihagen F, Nordsletten L, Madsen JE. Hemiarthroplasty or internal fixation for intracapsular displaced femoral neck fractures: randomised controlled trial. BMJ 2007;335(7632):1251‐4.

Jensen J. Personal communication September 10 2001.

Jensen J, Rasmussen TB, Christensen S, Holm‐Moller S, Lauritzen J. Internal fixation or prosthetic replacement in fresh femoral neck fractures [Abstract]. Acta Orthopaedica Scandinavica 1984;55:712.

Google Scholar

Jensen J, Rasmussen TB, Christensen S, Holm‐Moller S, Lauritzen J. Internal fixation or prosthetic replacement in fresh femoral neck fractures. A randomized clinical trial using cancellous bone screws (AO‐ASIF) or Austin Moore prosthesis. Unpublished report1982.

Google Scholar

Bachrach‐Lindstrom M, Johansson T, Unosson M, Ek AC, Wahlstrom O. Nutritional status and functional capacity after femoral neck fractures: a prospective randomised one‐year follow‐up study. Aging ‐ Clinical & Experimental Research 2000;12(5):366‐74.

Johansson T. Displaced femoral neck fractures; a prospective randomized study of clinical outcome, nutrition and costs [dissertation]. Linkoping: Linkoping University, 2002.

Johansson T, Bachrach‐Lindstrom M, Aspenberg P, Jonsson D, Wahlstrom O. The total costs of a displaced femoral neck fracture: Comparison of internal fixation and total hip replacement ‐ A randomised study of 146 hips. International Orthopaedics 2006;30(1):1‐6.

Johansson T, Bachrach‐Lindstrom M, Jonsson D, Aspenbert P, Wahlstrom O. Displaced femoral neck fractures: replace! sometimes fix. Journal of Bone and Joint Surgery ‐ British Volume 2004;86 Suppl 3:261.

Google Scholar

Johansson T, Jacobsson SA, Ivarsson I, Knutsson A, Wahlstrom O. Internal fixation versus total hip arthroplasty in the treatment of displaced femoral neck fractures: a prospective randomized study of 100 hips. Acta Orthopaedica Scandinavica 2000;71(6):597‐602.

Johansson T, Risto O, Knutsson A. Heterotopic ossification following internal fixation or arthroplasty for displaced femoral neck fractures: A prospective randomized study. International Orthopaedics 2001;25(4):223‐5.

Jonsson B, Sernbo I, Carlsson A, Fredin H, Johnell O. Social function after cervical hip fracture. A comparison of hook‐pins and total hip replacement in 47 patients. Acta Orthopaedica Scandinavica 1996;67(5):431‐4.

Mouzopoulos G, Stamatakos M, Arabatzi H, Vasiliadis G, Batanis G, Tsembeli A, et al. The four year functional result after a displaced subcapital hip fracture treated with three different surgical options. International Orthopaedics 2008;32(3):367‐73.

Neander G, Adolphson P, von Sivers K, Dahlborn M, Dalen N. Bone and muscle mass after femoral neck fracture. A controlled quantitative computed tomography study of osteosynthesis versus primary total hip arthroplasty. Archives of Orthopaedic and Trauma Surgery 1997;116(8):470‐4.

Parker MJ. Internal fixation or arthroplasty for displaced intracapsular fracture in the elderly ‐ a randomised trial [Abstract]. Acta Orthopaedica Scandinavica 1998;69 Suppl 280:31.

Google Scholar

Parker MJ, Khan RJ, Crawford J, Pryor GA. Hemiarthroplasty versus internal fixation for displaced intracapsular hip fractures in the elderly. A randomised trial of 455 patients. Journal of Bone and Joint Surgery ‐ British Volume 2002;84(8):1150‐5.

Parker MJ, Khan RJK, Crawford J, Pryor GA. Hemiarthroplasty or internal fixation for displaced intracapsular femoral neck fractures in the elderly: A prospective randomised controlled trial [abstract]. Journal of Bone and Joint Surgery ‐ British Volume 2004;86 (SUPP III):338.

Google Scholar

Parker MJ, Pryor G, Gurusamy K. Hemiarthroplasty versus internal fixation for displaced intracapsular hip fractures: a long‐term follow‐up of a randomised trial. Injury 2010;41(4):370‐3.

Parker MJ, Pryor GA. Internal fixation or arthroplasty for displaced cervical hip fractures in the elderly: a randomised controlled trial of 208 patients. Acta Orthopaedica Scandinavica 2000;71(5):440‐6.

Puolakka TJS, Laine H‐J, Tarvainen T, Aho H. Thompson hemiarthroplasty is superior to Ullevaal screws in treating displaced femoral neck fractures in patients over 75 years. A prospective randomized study with two‐year follow‐up. Annales Chirurgiae et Gynaecologiae 2001;90(3):225‐8.

Roden M, Ellene B, Fredin H. Treatment of displaced femoral neck fracture ‐ internal fixation versus bipolar endoprosthesis ‐ a preliminary report of a prospective randomized study [Abstract]. Acta Orthopaedica Scandinavica 1996;67 Suppl 270:33.

Google Scholar

Roden M, Schon M, Fredin H. Treatment of displaced femoral neck fractures: a randomised minimum 5‐year follow‐up study of screws and bipolar hemiarthroplasty in 100 patients. Acta Orthopedica Scandinavica 2003;74(1):42‐4.

Leonardsson O, Akesson K, Carlsson A, Rogmark C, Sernbo I. Nail or arthroplasty? 10‐year results of a randomised study of 450 patients. Journal of Bone and Joint Surgery ‐ British Volume 2010;92 (SUPP IV):552.

Google Scholar

Leonardsson O, Sernbo I, Carlsson A, Akesson K, Rogmark C. Long‐term follow‐up of replacement compared with internal fixation for displaced femoral neck fractures: results at ten years in a randomised study of 450 patients. Journal of Bone and Joint Surgery ‐ British Volume 2010;92(3):406‐12.

Rogmark C, Carlsson A, Johnell O, Sernbo I. A prospective randomised trial of internal fixation versus arthroplasty for displaced fractures of the neck of the femur; functional outcome for 450 patients at two years. Journal of Bone and Joint Surgery ‐ British Volume 2002;84(2):183‐8.

Rogmark C, Carlsson A, Johnell O, Sernbo I. Costs of internal fixation and arthroplasty for displaced femoral neck fractures: A randomized study of 68 patients. Acta Orthopaedica Scandinavica 2003;74(3):293‐8.

Rogmark C, Carlsson A, Johnell O, Sernbo I, Kreder HJ. Arthroplasty led to fewer failures and more complications than did internal fixation for displaced fractures of the femoral neck. Journal of Bone & Joint Surgery ‐ American Volume 2002;84(11):2108.

Google Scholar

Rogmark C, Johnell O, Sernbo I. Nail or arthroplasty ‐ a randomised study of displaced, cervical hip fractures [Abstract]. Acta Orthopaedica Scandinavica 1998;69 Suppl:280:30.

Google Scholar

Rogmark C, Sernbo I, Johnell O. Nail or arthroplasty: a randomised study of displaced femoral neck fractures: 2 year results [abstract]. American Academy of Orthopaedic Surgeons 68th Annual Meeting; 2001 Feb 27‐Mar 4; San Francisco (CA). http://www.aaos.org/wordhtml/anmt2001/sciprog/052.htm (accessed 23 Mar 2001).

de Roeck N. A prospective, randomised trial of internal fixation versus arthroplasty for displaced fractures of the neck of the femur [Letter]. Journal of Bone and Joint Surgery ‐ British Volume 2003;85(3):464‐5.

Ravikumar KJ, Marsh G. Internal fixation versus hemiarthroplasty versus total hip arthroplasty for displaced subcapital fractures of the femur ‐ 13 year results of a prospective randomised study. Injury 2000;31(10):793‐7.

Ravikumar KJ, Marsh G, Jairaj P. Internal fixation vs hemiarthroplasty vs total hip replacement for displaced subcapital fractures of the femur‐13 year results of a prospective randomised study. Journal of Bone and Joint Surgery ‐ British Volume 1998;80 Suppl 1:50‐1.

Google Scholar

Skinner P, Ellery J, Riley D, Beaumont A. Displaced subcapital fractures of the femur: which operation? [Abstract]. Journal of Bone and Joint Surgery. British Volume 1988;70(4):677.

Google Scholar

Skinner P, Riley D, Ellery J, Beaumont A, Coumine R, Shafighian B. Displaced subcapital fractures of the femur: a prospective randomized comparison of internal fixation, hemiarthroplasty and total hip replacement. Injury 1989;20(5):291‐3.

Raugstad TS, Soreide O, Molster A. Screw fixation versus primary prosthetic replacement in acute displaced femoral neck fractures [Abstract]. Acta Orthopaedica Scandinavica 1978;49:636.

Google Scholar

Soreide O, Alho A, Rietti D. Internal fixation versus endoprosthesis in the treatment of femoral neck fractures in the elderly. A prospective analysis of comparative costs and the consumption of hospital resources. Acta Orthopaedica Scandinavica 1980;51:827‐31.

Soreide O, Molster A, Raugstad TS. Internal fixation or primary prosthetic replacement for treatment of acute femoral neck fractures in the elderly: A prospective randomized study [Abstract]. Acta Orthopaedica Scandinavica 1979;50:805‐6.

Google Scholar

Soreide O, Molster A, Raugstad TS. Internal fixation versus primary prosthetic replacement in acute femoral neck fractures: a prospective, randomized clinical study. British Journal of Surgery 1979;66(1):56‐60.

Soreide O, Rietti D, Alho A. Internal fixation versus primary prosthetic replacement in acute femoral neck fractures. Cost effectiveness analysis [Abstract]. Acta Orthopaedica Scandinavica 1979;50:806.

Google Scholar

Keating JF, Grant A, Masson M, Scott NW, Forbes JF. Displaced intracapsular hip fractures in fit, older people: a randomised comparison of reduction and fixation, bipolar hemiarthroplasty and total hip arthroplasty. Health Technology Assessment (Winchester, England) 2005;9(41):iii‐iv, ix‐x, 1‐65. [http://www.ncchta.org/execsumm/summ941.htm]

Keating JF, Grant A, Masson M, Scott NW, Forbes JF. Randomised comparison of reduction and fixation, bipolar hemiarthroplasty, and total hip arthroplasty; treatment of displaced intracapsular hip fractures in healthy older people. Journal of Bone and Joint Surgery ‐ American Volume 2006;88(2):249‐60.

Keating JF, Masson MA, Forbes JF, Scott NW, Grant A. Randomized trial of reduction and fixation versus bipolar hemiarthroplasty versus total hip arthroplasty for displaced subcapital fractures in the fit older patient. Orthopaedic Trauma Association Annual Meeting 2002. http://www.hwbf.org/ota/am/ota02/otapa/OTA02641.htm. (accessed 25 Nov 2002).

Svenningsen S, Benum P, Nesse O, Furset OI. Dislocated femoral neck fractures in the elderly. A comparison of 3 methods of treatment [Larhalsbrudd hos eldre‐en sammenligning av tre behandlingsmetoder]. Nordisk Medicin 1985;100:256‐9.

Svenningsen S, Benum P, Nesse O, Furset OI. Femoral neck fractures in the elderly. A comparison of 3 therapeutic methods [Larhalsbrudd hos eldre. En sammenligning av tre behandlingsmetoder]. Tidsskrift for den Norske Laegeforening 1985;105(7):492‐5.

Blomfeldt R, Tornkvist H, Ponzer S, Soderqvist A, Tidermark J. Comparison of internal fixation with total hip replacement for displaced femoral neck fractures. Randomized, controlled trial performed at four years. Journal of Bone and Joint Surgery ‐ American Volume 2005;87(8):1680‐8.

Kamath S. Internal fixation compared with total hip replacement for displaced femoral neck fractures in the elderly [Comment. Letter]. Journal of Bone and Joint Surgery ‐ British Volume 2004;86(1):148‐9.

Tidermark J. Quality of life after femoral neck fractures. Acta Orthopaedica Scandinavica 2003;74 Suppl 309:1‐42.

Google Scholar

Tidermark J, Bergstrom G, Svensson O, Tornkvist H, Ponzer S. Responsiveness of the EuroQol (EQ 5‐D) and the SF‐36 in elderly patients with displaced femoral neck fractures. Quality of Life Research 2003;12(8):1069‐79.

Tidermark J, Ponzer S, Svensson O, Soderqvist A. Tornkvist H. Internal fixation compared with total hip replacement for displaced femoral neck fractures in the elderly. A randomised, controlled trial. Journal of Bone and Joint Surgery ‐ British Voume 2003;85(3):380‐8.

Google Scholar

Tidermark J, Ponzer S, Svensson O, Tornkvist. Internal fixation vs. primary total hip arthroplasty for displaced femoral neck fractures: A prospective randomised study [Abstract]. Journal of Orthopaedic Trauma 2000;14(2):134‐5.

van Dortmont LM, Douw CM, van Breukelen AM, Laurens DR, Mulder PG, Wereldsma JC, et al. Cannulated screws versus hemiarthroplasty for displaced intracapsular femoral neck fractures in demented patients. Annales Chirurgiae et Gynaecologiae 2000;89(2):132‐7.

van Dortmont LMC. Personal communication September 9 2001.

van Vugt AB, Oosterwijk WM, Goris RJ. Osteosynthesis versus endoprosthesis in the treatment of unstable intracapsular hip fractures in the elderly. A randomised clinical trial. Archives of Orthopaedic and Trauma Surgery 1993;113(1):39‐45.

van Vugt AB. Oosterwijk WM. Goris RJ. Predictive value of early scintimetry in intracapsular hip fractures. A prospective study with regard to femoral head necrosis, delayed union and non‐union. Archives of Orthopaedic & Trauma Surgery 1993;113(1):33‐8.

Google Scholar

Referencias de los estudios excluidos de esta revisión

Ir a:

estudios incluidos
otras referencias
otras versiones publicadas

Bray TJ, Smith Hoefer E, Hooper A, Timmerman L. The displaced femoral neck fracture. Internal fixation versus bipolar endoprosthesis. Results of a prospective, randomized comparison. Clinical Orthopaedics and Related Research 1988;(230):127‐40.

Google Scholar

Kirschenbaum IH. The displaced femoral neck fracture: internal fixation versus bipolar endoprosthesis. Results of a prospective, randomized comparison [letter]. Clinical Orthopaedics and Related Research 1989;(240):311‐2.

Google Scholar

El‐Abed K, McGuinness A, Brunner J, Dallovedova P, O'Connor P, Kennedy JG. Comparison of outcomes following uncemented hemiarthroplasty and dynamic hip screw in the treatment of displaced subcapital hip fractures in patients aged greater than 70 years. Acta Orthopaedica Belgica 2005;71(1):48‐54.

Hunter G A. A comparison of the use of internal fixation and prosthetic replacement for fresh fractures of the neck of the femur. British Journal of Surgery 1969;56(3):229‐32.

Hunter GA. A further comparison of the use of internal fixation and prosthetic replacement for fresh fractures of the neck of the femur. British Journal of Surgery 1974;61(5):382‐4.

Neander G. Reduction and fixation versus total hip arthroplasty in the treatment of displaced femoral neck fractures. Results after four years of a prospective randomised study in 100 patients. Displaced femoral neck fractures. Studies on osteosynthesis and total hip arthroplasty. Stockholm: Division of Orthopaedics, Karolinska Institutet, Danderyds Hospital, 2000:1‐21. [ISBN 91 ‐628‐4167 ‐X]

Google Scholar

Sköldenberg O. Total hip arthroplasty compared to internal fixation for displaced intracapsular fractures of the femoral neck. ClinicalTrials.gov register. http://clinicaltrials.gov/show/NCT01344772 (accessed 28/08/11)2011. [NCT01344772]

Google Scholar

Parker MJ. Internal fixation or arthroplasty for displaced subcapital fractures in the elderly?. Injury 1992;23(8):521‐4.

Pathi KM, Murthy BS. Hemiarthroplasty versus internal fixation for displaced sub‐capital fracture neck femur. Indian Journal of Orthopedics 1989;23(2):149‐51.

Google Scholar

Riley TBH. Knobs or screws? ‐ a prospective trial of prosthetic replacement against internal fixation of subcapital fractures [Abstract]. Journal of Bone and Joint Surgery ‐ British Volume 1978;60(1):136.

Google Scholar

Rodriguez J, Herrara A, Canales V, Serrano S. Epidemiologic factors, morbidity and mortality after femoral neck fractures in the elderly. A comparative study: internal fixation vs. hemiarthroplasty. Acta Orthopaedica Belgica 1987;53(4):472‐9.

Shafee M, Tariq MA, Chisti MK. Intracapsular fracture neck of femur. Medical Forum Monthly 2007;18(3):6‐10.

Google Scholar

Sikorski JM, Barrington R. Internal fixation versus hemiarthroplasty for the displaced subcapital fracture of the femur. Journal of Bone and Joint Surgery ‐ British Volume 1981;63(3):357‐61.

Stewart HD. Pugh's nail fixation versus Thompson's prosthesis for displaced subcapital fractures of the femur. Injury 1984;15(4):227‐31.

Referencias adicionales

Ir a:

estudios incluidos
estudios excluidos
otras versiones publicadas

Bhandari M, Devereaux PJ, Swiontkowski MF, Tornetta P, Obremskey W, Koval KJ, et al. Internal fixation compared with arthroplasty for displaced fractures of the femoral neck. A meta‐analysis. Journal of Bone and Joint Surgery ‐ American Volume 2003;85(9):1673‐81.

Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327:557‐60.

Lefebvre C, Manheimer E, Glanville J. 6.4.11 Search filters. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2 (updated September 2009). The Cochrane Collaboration, 2009. Available from www.cochrane‐handbook.org.

Lu‐Yao GL, Keller RB, Littenberg B, Wennberg JE. Outcomes after displaced fractures of the femoral neck. A meta‐analysis of one hundred and six published reports. Journal of Bone and Joint Surgery ‐ American Volume 1994;76(1):15‐25.

Parker MJ, Stockton G, Gurusamy KS. Internal fixation implants for intracapsular proximal femoral fractures in adults. Cochrane Database of Systematic Reviews 2001, Issue 4. [DOI: 10.1002/14651858.CD001467]

Parker MJ, Gurusamy KS, Azegami S. Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. Cochrane Database of Systematic Reviews 2010, Issue 6. [DOI: 10.1002/14651858.CD001706.pub4]

Rogmark C, Johnell O. Primary arthroplasty is better than internal fixation of displaced femoral neck fractures: a meta‐analysis of 14 randomized studies with 2,289 patients. Acta Orthopaedica 2006;77(3):359‐67.

Referencias de otras versiones publicadas de esta revisión

Ir a:

estudios incluidos
estudios excluidos
otras referencias

Masson M, Parker MJ, Fleischer S. Internal fixation versus arthroplasty for intracapsular proximal femoral fractures in adults. Cochrane Database of Systematic Reviews 2003, Issue 2. [DOI: 10.1002/14651858.CD001708]

Parker MJ, Gurusamy KS. Internal fixation versus arthroplasty for intracapsular proximal femoral fractures in adults. Cochrane Database of Systematic Reviews 2006, Issue 4. [DOI: 10.1002/14651858.CD001708.pub2]

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Ir a:

estudios excluidos

Blomfeldt 2005

Methods	Randomisation by: sealed envelopes technique
Participants	One hospital, Karolinska Institute at Stockholm Söder Hospital, Sweden. 60 patients. Characteristics of participants: Mean age: 84 years. Male: 6 (10%) Loss to follow‐up: 1 (2%) Inclusions: short portable mental status questionnaire of less than 3/10 or a diagnosis of dementia, displaced fracture of the femoral neck, aged 70 years plus, able to walk independently Exclusions: pathological fractures, fracture more than 24 hours from occurrence, rheumatoid arthritis, osteoarthritis
Interventions	1. Reduction and fixation with two cannulated screws versus 2. Uncemented Moore unipolar hemiarthroplasty inserted via an anterolateral modified Hardinge approach
Outcomes	Follow‐up for 24 months OUTCOMES COLLECTED BY TRIAL (a) Operative details: length of surgery in minutes, operative blood loss, number of patients transfused (b) Complications related to type of operation: For internal fixation: fixation failure, early redisplacement, non‐union, avascular necrosis, fracture around implant For replacement arthroplasty: fracture around implant, dislocation Re‐operations Wound healing: superficial, infection, deep sepsis (c) Postoperative complications: none (d) Postoperative care outcomes: none (e) Anatomical restoration: none (f) Final outcome measures: Mortality at 4, 12, 24 months Pain at 4, 12, 24 months; Activities of daily living score; Health related quality of life questionnaire; Walking ability (Charnley score); Movement of the hip (Charnley score); Failure to regain mobility (g) Economic cost: none
Notes	Additional information supplied by trialists
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Not stated
Allocation concealment (selection bias)	Unclear risk	'sealed envelopes technique'
Blinding (performance bias and detection bias) Were the assessors of pain and function at follow‐up blinded to the treatment allocation	High risk	not mentioned

Davison 2001

Methods	Randomisation by: computer generation of random numbers.
Participants	General hospital, Leicester, UK. From 1 January 1991 to 31 January 1996 280 patients. Characteristics of participants: Median age: in each group 73, 76, 75 (range 69 to 79). Male: 67 (24%) Loss to follow‐up: 50 (17.9%) Inclusions: Displaced intracapsular fracture of the proximal femur, Aged 65 to 79 Exclusions: Abbreviated mental test score < 5/13, uncontrolled Parkinson's disease, pathological fracture, disseminated malignancy, Paget's disease, rheumatoid arthritis, long‐term steroids
Interventions	1. Reduction and fixation with 'Ambi' compression hip screw (AHS) and 2 hole plate versus: 2. Cemented Thompson unipolar hemiarthroplasty (Hardinge approach) versus 3. Cemented Monk bipolar hemiarthroplasty (Hardinge approach)
Outcomes	Follow‐up for 5 years at 6/52, 1/12, 24/12, 36/12, 48/12, 60/12. Actual minimum 2 years OUTCOMES COLLECTED BY TRIAL (a) Operative details: none (b) Complications related to type of operation: For internal fixation: non‐union, migration and cut‐out of screw, avascular necrosis and collapse, degeneration of joint For replacement arthroplasty: acetabular erosion, loosening and subsidence (c) Postoperative complications: none (d) Postoperative care outcomes: none (e) Anatomical restoration: none (f) Final outcome measures: Mortality at 6, 12, 18, 24, 30, 36 months and time to death Time to revision Harris hip score Subjective function and satisfaction Functional outcome from home assessment Barthel index (for activities of daily living) Time to preinjury state and satisfaction with outcome (g) Economic cost: none
Notes	Discrepancy with abstract 1997 which mentions 282 patients.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	'computer generation of random numbers'
Allocation concealment (selection bias)	Unclear risk	'computer generation of random numbers'
Blinding (performance bias and detection bias) Were the assessors of pain and function at follow‐up blinded to the treatment allocation	Low risk	Home assessment of patients by observer blinded to type of operative treatment

Frihagen 2007

Methods	Randomisation by: sealed opaque numbered envelopes.
Participants	One university hospital, Oslo, Norway From September 2002 to March 2004 222 fractures in 221 patients Mean age: 83 years (range not stated). Male: 57 (26%) Loss to follow‐up: 1 (0.5%) Inclusions: age 60 years and above, displaced fracture of the femoral neck, previously ambulant Exclusions: pathological fractures, fracture more than 96 hours from occurrence, previous hip pathology, unfit for either procedure, living outside the hospital area
Interventions	1. Reduction and fixation with two Olmed screws versus 2. Cemented Charnley‐Hastings bipolar hemiarthroplasty
Outcomes	Follow‐up for 48 months OUTCOMES COLLECTED BY TRIAL (a) Operative details: length of surgery in minutes, operative blood loss, number of patients transfused (b) Complications related to type of operation: For internal fixation: fixation failure, early redisplacement, non‐union, avascular necrosis, fracture around implant For replacement arthroplasty: fracture around implant, dislocation, loosening of the implant Re‐operations Wound healing: superficial, infection, deep sepsis (c) Postoperative complications: deep vein thrombosis pulmonary embolism pressure sores confusion wound infections (d) Postoperative care outcomes: length of hospital stay (e) Anatomical restoration: none (f) Final outcome measures: Mortality at 1, 4, 12 and 24 months Pain (visual analogue scale) at 4 months, 1 and 2 years Harris hip score at 4 months, 1 and 2 years Eq 5d score at 4 months, 1 and 2 years Barthel index score at 4 months, 1 and 2 years (g) Economic cost: none
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	'envelopes sealed and mixed before they were numbered'
Allocation concealment (selection bias)	Low risk	'opaque envelopes' which were sealed and mixed before being numbered
Blinding (performance bias and detection bias) Were the assessors of pain and function at follow‐up blinded to the treatment allocation	Low risk	The physiotherapist undertaking the follow‐up assessments was blinded to the treatment group

Jensen 1984

Methods	Randomisation by: random numbers using sealed opaque envelopes.
Participants	One hospital, Ashrus, Denmark. From 2 January 1975 to 31 August 1978 102 patients Characteristics of participants: Median age: in each group 80.5 and 70 years. Male: 32 (31%) Reported that the fixation group included more patients with a poor prognosis. Loss to follow‐up: 2 (2%) Inclusions: Fresh and non‐pathological fractures of the femoral neck, displaced to stage III or IV Garden, aged 70 years plus Exclusions: pathological fractures (by inference)
Interventions	1. Reduction and fixation with 4 AO screws versus 2. Uncemented Moore unipolar hemiarthroplasty inserted via a posterior approach
Outcomes	Follow‐up for 24 months OUTCOMES COLLECTED BY TRIAL (a) Operative details: length of surgery in minutes (b) Complications related to type of operation: For internal fixation: fixation failure, early redisplacement, non‐union, avascular necrosis For replacement arthroplasty: prosthesis loosening, settling, acetabular protrusion, periarticular calcification (grade 3), allergy to metal For both methods of treatment:per or subtrochanteric fracture, femoral shaft fracture Re‐operations Wound healing: superficial, infection, deep sepsis, haematoma (c) Postoperative complications: Deep vein thrombosis, Pulmonary embolism Medical complications: cardiopulmonary, neurological, gastrointestinal, urinary retention, pressure sore (d) Postoperative care outcomes: Mean time to weight‐bearing (e) Anatomical restoration: none (f) Final outcome measures: Mortality at 1, 6, 12, 24 months Need for walking aids Social function Stitchfield's hip assessment (incorporates pain, range of movement, ability to walk) (g) Economic cost: none
Notes	Additional information from Dr Jensen
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	random numbers using sealed opaque envelopes.
Allocation concealment (selection bias)	Unclear risk	random numbers using sealed opaque envelopes
Blinding (performance bias and detection bias) Were the assessors of pain and function at follow‐up blinded to the treatment allocation	High risk	no mention of blinding

Johansson 2002

Methods	Randomisation by: sequentially numbered sealed envelopes. Only those patients allocated to THR were consented to the study
Participants	One orthopaedic hospital, Linkoping, Sweden. From September 1994 to May 1998 143 patients. Characteristics of participants: Mean age: 84 (range 75 to 101) Male: 34 (24%) Loss to follow‐up: 15 (10%) Inclusions: displaced and acute femoral neck fracture, aged 75 and over, dementia not an exclusion, ambulatory before trauma Exclusions: contraindications to major surgery, malignancy of significance, signs of rheumatic joint disease, anaesthetically unfit for total hip arthroplasty
Interventions	1. Reduction and fixation with 2 parallel Olmed screws versus 2. Total hip replacement, Lubinus IP (cemented, dorsolateral approach)
Outcomes	Follow‐up for 24 months OUTCOMES COLLECTED BY TRIAL (a) Operative details: none (b) Complications related to type of operation: For internal fixation: redisplacement, non‐union, avascular necrosis, intolerable hip pain, local pain from screws For replacement arthroplasty: stiff hip, dislocations For both methods of treatment: re‐operations, superficial infection, deep wound infection (c) Postoperative complications: Deep vein thrombosis Pneumonia Medical complications, Gastrointestinal bleed, heart failure Cerebrovascular accident ‐Myocardial infarction Hospital stay (d) Postoperative care outcomes: none (e) Anatomical restoration:none (f) Final outcome measures: Mortality at 3, 12, 24 months Harris hip score after surgery, at 3/12, 1 and 2 years (g) Economic costs: Cost is Swedish Korona
Notes	146 fractures in 143 patients. 5 further cases were allocated to THR but refused to participate and excluded and a further 11 were excluded after randomisation. Additional publication looking at heterotopic ossification. Appears to use same patients as main study although there is a discrepancy in the dates patients were included between the two papers. Additional information supplied by Dr Johansson.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Not stated how the envelopes were prepared.
Allocation concealment (selection bias)	Unclear risk	Numbered sequentially sealed envelopes were used and then only those allocated to THR were consented to the study. It remains unclear if for those allocated to THR any patients refused and were then excluded.
Blinding (performance bias and detection bias) Were the assessors of pain and function at follow‐up blinded to the treatment allocation	High risk	no mention of blinding

Jonsson 1996

Methods	Randomisation by: sealed envelope.
Participants	One hospital, Malmo, Sweden. 1990s 47 patients. Characteristics of participants: Median age fixation 79, arthroplasty 80 (range 67 to 89) Male: 11 (23%) Loss to follow‐up: 2 (4%) Inclusions: cervical hip fracture, Garden III or IV; fully ambulatory and living in own homes before the fracture Exclusions: fracture > 48 hours old at time of admission, considered by anaesthetist not to be healthy enough to with stand strain of a hip replacement
Interventions	1. Reduction and fixation with Hansson hook pins versus 2. Total hip replacement, Charnley (trochanteric osteotomy)
Outcomes	Follow‐up for 24 months OUTCOMES COLLECTED BY TRIAL (a) Operative details: none (b) Complications related to type of operation: For internal fixation: non‐union, late segmental collapse For replacement arthroplasty: dislocation For both methods of treatment: superficial infection (c) Postoperative complications: Confusion Deep vein thrombosis Pulmonary embolism Bedsore Urinary tract infection Myocardial infarction Heart failure (d) Postoperative care outcomes: Length of hospital stay (e) Anatomical restoration: none (f) Final outcome measures: Mortality at 24 months Social, walking, pain (g) Economic cost: none
Notes	Pilot study. 50 randomised. 3 excluded after randomisation.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	'sealed envelope'
Allocation concealment (selection bias)	Unclear risk	'sealed envelope'
Blinding (performance bias and detection bias) Were the assessors of pain and function at follow‐up blinded to the treatment allocation	High risk	no mention of blinding

Mouzopoulos 2008

Methods	Method of randomisation: alternation
Participants	Orthopaedic unit in Athens, Greece From April 1999 to April 2002 129 patients with a displaced intracapsular fracture. Mean age: 74 years (range not stated) Percentage male: 31 (28% of 109) Follow‐up: mean 48 months Loss to follow‐up: 2 (4%) lost but in addition, 8 excluded because of previous hip fracture and 18 patients who had revision surgery were not followed‐up for the functional assessments. Inclusions: age over 70 years, good cognitive function, moderately dependent, displaced intracapsular fracture Exclusions: Pagets disease, history of cancer, rheumatoid arthritis
Interventions	1. Internal fixation with a Sliding Hip Screw versus: 2. Merte hemiarthroplasty versus 3. De Puy total hip replacement. It was not stated if the prostheses were cemented in place
Outcomes	Follow‐up for 48 months OUTCOMES COLLECTED BY TRIAL (a) Operative details: none (b) Complications related to type of operation Re‐operations (1 and 4 years) (c) Postoperative complications: none (d) Postoperative care outcomes: Length of hospital stay (e) Anatomical restoration: none (f) Final outcome measures: Mortality (1 and 4 years) Barthel score (1 and 4 years) Harris hip score (1 and 4 years) Range of movement Walking speed (g) Economic cost: none
Notes	Eight patients who had had a previous hip fracture and 18 patients who had a revision operation were excluded from the follow‐up assessments.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	High risk	'these 129 participants were randomly divided, by two orthopaedic surgeons, into three groups according to the type of surgical operation there were to undergo, following this order: hemi‐arthroplasty, total arthroplasty, internal fixation, etc"
Allocation concealment (selection bias)	High risk	alternation: as above
Blinding (performance bias and detection bias) Were the assessors of pain and function at follow‐up blinded to the treatment allocation	Low risk	Assessors of function were blinded to the type of surgery

Neander 1997

Methods	Randomisation by: closed envelopes.
Participants	One hospital, Stockholm, Sweden. From February 1990 to October 1990 20 patients. Loss to follow‐up: none Characteristics of participants: Mean age: 86 (range 79 to 94) Male: 5 (25%) Inclusions: fresh displaced femoral neck fracture, stage III‐IV; aged over 65, admitted from own homes Exclusions: history of previous disabilities of the legs, hormonal therapy or other medications or suffered from illnesses known to affect the bone metabolism
Interventions	1. Reduction and fixation with 2 parallel Olmed screws versus 2.Total hip replacement, BiMetric (cemented, posterior approach)
Outcomes	Follow‐up for 18 months OUTCOMES COLLECTED BY TRIAL (a) Operative details: none (b) Complications related to type of operation: Infection Re‐operations (c) Postoperative complications: Pulmonary embolism Myocardial infarction Cerebral infarction (d) Postoperative care outcomes: none (e) Anatomical restoration: none (f) Final outcome measures: Mortality at 18 months Bone mineral density Harris hip score (g) Economic cost: none
Notes	Four patients not included in bone mineral density analysis
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	no mentioned
Allocation concealment (selection bias)	Unclear risk	closed envelopes
Blinding (performance bias and detection bias) Were the assessors of pain and function at follow‐up blinded to the treatment allocation	High risk	no mention of blinding

Parker 2002

Methods	Randomisation by: sealed opaque identical envelopes containing the instructions about the type of operation.
Participants	One hospital, Peterborough, UK. From July 1991 to February 2001 455 patients. Characteristics of participants: Mean age 82 years (range 71 to 103) Male: 91 (20%) Loss to follow‐up: none at one year. Two in the long term follow‐up report. Inclusions: displaced cervical hip fracture (defined as clear displacement of the fracture on both anteroposterior and lateral radiograms), aged > 70 years Exclusions: rheumatoid arthritis, chronic renal failure, significant arthritis of hip, patient unfit for either surgical procedure, delay > 48 hours fracture to surgery, Paget's disease, metabolic bone disease
Interventions	1. Reduction and fixation with 3 AO screws versus 2. Uncemented Austin Moore unipolar hemiarthroplasty (anterolateral approach)
Outcomes	Follow‐up for minimum 1 year for all survivors for initial report. Subsequent long‐term follow‐up report with mean follow‐up of survivors of 10.6 years (range 9‐15 years) OUTCOMES COLLECTED BY TRIAL (a) Operative details: Length of surgery in minutes Operative blood loss in ml Units blood transfused Operative blood pressure fall (b) Complications related to type of operation For internal fixation: non‐union, avascular necrosis For replacement arthroplasty: dislocation, loosening of prosthesis For both methods: Fracture below/around implant Re‐operations Superficial wound infection Deep wound infection (c) Postoperative complications: Deep vein thrombosis Pulmonary embolism Congestive cardiac failure Confusion post‐op Pressure sores Urinary retention Gastrointestinal bleeding Gastric aspiration Renal failure Clostridia diarrhoea Amputation leg (d) Postoperative care outcomes Length hospital stay/orthopaedic ward only, total stay, stay inclusive of readmission time Mean dose morphine post‐op Mean number co‐proxamol (e) Anatomical restoration: Shortening Loss of flexion (f) Final outcome measures: Mortality for minimum follow‐up of 9 years Pain scores (Charnley) (up to 9 to 15 years) Residence (up to 9 to 15 years) ‐Reduction in mobility (up to 9‐15 years) ‐Walking aids (up to 9‐15 years) ‐Activities of daily living score (g) Economic cost: Mean cost including readmissions and additional surgery
Notes	One year results published as for the principle reference. Subsequent report with long‐term follow up of the patients. Additional data supplied by MJ Parker.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	envelopes containing the operative instructions were not independently prepared
Allocation concealment (selection bias)	Unclear risk	sealed opaque identical envelopes
Blinding (performance bias and detection bias) Were the assessors of pain and function at follow‐up blinded to the treatment allocation	High risk	All outcomes recorded by lead trialists

Puolakka 2001

Methods	Randomisation by: sealed envelopes.
Participants	one centre, Tampere, Finland From February 1994 31 patients Characteristics of participants: Mean age 81 yr fixation, 82 years arthroplasty (range 77 to 90) 5 (16%) male Loss to follow‐up: none Inclusions: femoral neck fracture, Garden 3‐4; aged > 75 years Exclusions: unable to walk independently (without other person's help), rheumatoid arthritis
Interventions	1. Reduction and fixation with 3 Ulleval screws versus 2. Cemented Thompson unipolar hemiarthroplasty (posterior approach)
Outcomes	Follow‐up for 2 years at 6 weeks, 3, 12, 24 months OUTCOMES COLLECTED BY TRIAL (a) Operative details Mean length of surgery in minutes Mean operative blood loss in ml (b) Complications related to type of operation Internal fixation/pseudarthrosis, osteonecrosis, failed osteosynthesis Replacement arthroplasty/evaluation of stem position and cementing For both methods: Re‐operation, wound infection (c) Postoperative complications Immediate systemic complications (d) Postoperative care outcomes: none (e) Anatomical restoration: none (f) Final outcome measures Mortality 3 and 24 months (g) Economic cost
Notes	Study terminated early due to high complication rate in fixation group. One patient randomised to receive internal fixation was excluded from the study as acceptable reduction of the fracture could not be achieved and this patient was treated with an arthroplasty.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	not stated
Allocation concealment (selection bias)	Unclear risk	'sealed envelopes'
Blinding (performance bias and detection bias) Were the assessors of pain and function at follow‐up blinded to the treatment allocation	High risk	no mention of blinding of assessors of pain and function

Roden 2003

Methods	Randomisation by: sealed envelopes.
Participants	One hospital, Sundsvall County Hospital, Sweden. From February 1992 to September 1994 100 patients. Characteristics of participants: Mean age 81 years (range 70 to 96) Male: 29 (29%) Loss to follow‐up: not stated Inclusions: displaced cervical hip fracture, aged > 70 years Exclusions: senile dementia, immobility, unable to consent, refusal, delay > 12 hours fracture to surgery, 'medical findings'
Interventions	1. Reduction and fixation with 2 von Bahr screws versus 2. Cemented Variokopf bipolar hemiarthroplasty (posterior approach)
Outcomes	Follow‐up for minimum 5 years all survivors OUTCOMES COLLECTED BY TRIAL (a) Operative details: Length of surgery in minutes Operative blood loss in ml Units blood transfused (b) Complications related to type of operation For internal fixation: non‐union, avascular necrosis For replacement arthroplasty: dislocation For both methods: Re‐operation Superficial wound infection Deep wound infection (c) Postoperative complications: not clearly stated (d) Postoperative care outcomes Length hospital stay /orthopaedic ward only Number discharged home directly (e) Anatomical restoration: no outcomes (f) Final outcome measures: Mortality at 2 and 5 years Pain at 4 months and 5 years (g) Economic cost: none given
Notes	Extra information supplied by trialists
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	not stated
Allocation concealment (selection bias)	Unclear risk	'sealed envelopes' opened in the operating room
Blinding (performance bias and detection bias) Were the assessors of pain and function at follow‐up blinded to the treatment allocation	High risk	no mention of blinding of assessors of pain and function

Rogmark 2002

Methods	Randomisation by: sealed, opaque numbered envelopes drawn sequentially.
Participants	Multicentre: 12 centres in Sweden From 1995 to 1997 409 patients Characteristics of participants: Mean age male, 80.7 years Mean age female, 81.8 years Male: 85 (21%) Loss to follow‐up at 2 years: 41/450 were drop‐outs (10 planned surgery stopped due to medical reasons, 8 lost to follow‐up, 7 not meeting criteria, 13 withdrawals, 3 died before surgery). 409 included in analysis. Inclusions: cervical hip fracture, graded 3‐4; independent, mentally alert Exclusions: mentally confused, bedridden or institution dwelling, rheumatoid arthritis, fracture > 2 days
Interventions	1. Reduction and fixation with Hansson hook‐pins or Olmed screws versus 2. Replacement arthroplasty, various types, choice of surgeon and included cemented and uncemented types.
Outcomes	Follow‐up for 24 months OUTCOMES COLLECTED BY TRIAL (a) Operative details: Time admission to surgery. Length of surgery in minutes (b) Complications related to type of operation For internal fixation: non‐union or early redisplacement, avascular necrosis, pain. For replacement arthroplasty: dislocation, diaphyseal fracture. For both methods: Re‐operation Deep infection Failure (c) Postoperative complications: stroke, pulmonary or cardiac insufficiency, pressure sores, venous thromboembolic complication (d) Postoperative care outcomes Length of hospital stay. (e) Anatomical restoration: None (f) Final outcome measures: Mortality, perioperative and at 4, 12 and 24 months Functional outcome (walking ability and pain) Pain Mobility (g) Economic cost: for a subgroup of 68 cases
Notes	Twenty‐six patients did not attend 2 year control (failure status reported at 1 year) Additional information supplied by the trialists Cost information was reported in a paper in 2003 for a subgroup of 68 cases. Subsequent report of this study with a long‐term follow‐up of included patients (Leonardsson 2010) presents the outcomes of mortality, surgical complications, re‐operations, hip pain and mobility. Mean follow up was 123/124 months with 4 patients lost to follow‐up. The number of dislocations was reported as 15 in the original report but 12 in the later report with two of these dislocations occurring after the initial report was made.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	not clearly stated
Allocation concealment (selection bias)	Low risk	'sealed numbered opaque envelopes'
Blinding (performance bias and detection bias) Were the assessors of pain and function at follow‐up blinded to the treatment allocation	High risk	no mention of blinding of assessors of pain and function

Skinner 1989

Methods	Randomisation by: day of week unclear due to reporting of results in percentages.
Participants	One hospital, Kent, UK. From December 1984 to December 1986 271 patients Characteristics of participants: Mean age: 79.7 years Male: 27 (10%) Loss to follow‐up: not clear. Inclusions: displaced subcapital femoral neck fracture (Garden III and IV, Aged 65 and over, patients with compromised mental state included Exclusions: old fractures, pathological fractures, doubt regarding grading of fracture, rheumatoid arthritis
Interventions	1. Reduction and fixation with Richard's compression screw plate versus: 2. Uncemented Austin Moore unipolar hemiarthroplasty (posterolateral approach) versus 3.Total hip replacement, cemented Howse II (posterolateral approach)
Outcomes	Follow‐up for 13 years OUTCOMES COLLECTED BY TRIAL (a) Operative details: none (b) Complications related to type of operation: For internal fixation: non‐union, failure of fixation, femoral head collapse or avascular necrosis For replacement arthroplasty: acetabular erosion, loosening, heterotopic ossification, dislocation For both methods: revision rate, deep infection (c) Postoperative complications: Pulmonary embolism Myocardial infarction perioperative death Peroneal nerve palsy Iatrogenic femoral fracture (d) Postoperative care outcomes: none (e) Anatomical restoration: none (f) Final outcome measures: Mortality at 2 months, 1 and 13 years. 13 year survival analysis Pain and mobility (Sikorski and Barrington) Functional results by questionnaire Harris hip score at 13 years (g) Economic cost: none
Notes	290 patients randomised; 19 patients excluded after randomisation (patients not traceable, missing medical records, wrong randomisation or patients unfit to be assessed) 1 year results published in Injury 1989 for 278 patients.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	High risk	'randomly allocated according to one of the following three methods of treatment according to the day of the week on which they were admitted'
Allocation concealment (selection bias)	High risk	'randomly allocated according to one of the following three methods of treatment according to the day of the week on which they were admitted'
Blinding (performance bias and detection bias) Were the assessors of pain and function at follow‐up blinded to the treatment allocation	High risk	No mention of blinding of assessors of pain and function

Soreide 1979

Methods	Randomisation by: date of birth.
Participants	One hospital, Bergen, Norway. From 1 October 1974 to 30 September 1976 104 patients Characteristics of participants: Mean age: fixation 77.9 , arthroplasty 78.3 years. Male: 21 (20%) Loss to follow‐up: 7 (6.7%) Inclusions: acute femoral neck fracture (Garden II‐IV), aged over 67 Exclusions: by implication pathological fractures, metastatic carcinoma
Interventions	‐Reduction and fixation with von Bahr screws versus ‐Bipolar hemiarthroplasty, Christiansen
Outcomes	Follow‐up for 12 months Mean: fixation 14.7 months, arthroplasty 14.5 months OUTCOMES COLLECTED BY TRIAL (a) Operative details: Length of surgery Transfusion (b) Complications related to type of operation: For internal fixation: mechanical failure, necrosis of femoral head For replacement arthroplasty: postoperative luxation, delerin luxation For both methods: re‐operation, superficial infection, haematoma (c) Postoperative complications: Deep vein thrombosis and Pulmonary embolism combined Cardiopulmonary Neurological Drug exanthema Urinary retention (d) Postoperative care outcomes Length of necessary hospital stay Days to mobilisation (e) Anatomical restoration: Range of movement (f) Final outcome measures: Mortality at 1, 6, 12 months Walking ability and aids used Stitchfield's hip assessment (pain, movement, capacity for walking) (g) Economic cost: Includes initial stay and stay inclusive of re‐operations
Notes	Fractures include Garden II‐IV. Discrepancy in numbers originally randomised 121 or 123. 17 excluded after randomisation.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	High risk	'randomized into two groups according to their date of birth'
Allocation concealment (selection bias)	High risk	'randomized into two groups according to their date of birth'
Blinding (performance bias and detection bias) Were the assessors of pain and function at follow‐up blinded to the treatment allocation	High risk	No mention of blinding of assessors of pain and function

STARS 2006

Methods	Randomisation by: computer telephone randomisation service.
Participants	11 hospitals in Scotland, UK 298 patients Characteristics of participants: Mean age: 75 years Male: 66 (22%) Loss to follow‐up: 2 (0.7%) Inclusions: mobile, mental test score equal to or more than 7/10, aged 60 and above, no serious concomitant disease, displaced intracapsular fracture Exclusions: those not satisfying the above criteria
Interventions	1. Reduction and fixation with cancellous screws or sliding hip screw versus: 2. Cemented bipolar hemiarthroplasty versus 3. Cemented total hip replacement (surgical approach for arthroplasty was that preferred by the surgeon)
Outcomes	Follow‐up for 24 months OUTCOMES COLLECTED BY TRIAL (a) Operative details: length of surgery in minutes, number transfused (b) Complications related to type of operation: For internal fixation: fixation failure, early redisplacement, non‐union, avascular necrosis For replacement arthroplasty: dislocation Re‐operations Wound healing: superficial infection, deep sepsis (c) Postoperative complications: Deep vein thrombosis Pulmonary embolism Cerebrovascular accident Septicaemia Other medical complications (d) Postoperative care outcomes: none (e) Anatomical restoration: none (f) Final outcome measures: Mortality at 4, 12, 24 months Pain at 4, 12, 24 months Walking score at 4, 12, 24 months Function score at 4, 12, 24 months EQ5D score at 4, 12, 24 months (g) Economic cost: estimated cost for the three trial procedures
Notes	Additional information supplied by trialists
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	'centralized fully automated computer‐based telephone service'
Allocation concealment (selection bias)	Low risk	'centralized fully automated computer‐based telephone service'
Blinding (performance bias and detection bias) Were the assessors of pain and function at follow‐up blinded to the treatment allocation	High risk	No mention of blinding of assessors of pain and function

Svenningsen 1985

Methods	Randomisation by: method not stated.
Participants	One hospital, Trondheim, Norway. From October 1977 to January 1980 169 patients. Characteristics of participants: Mean age in each group 79 both fixations 83 arthroplasty (range 70 to 93) Male: 42 (24.9%) Loss to follow‐up: 7 (4.1%) Inclusions: displaced femoral neck fracture (Garden III‐IV), aged over 70 Exclusions: not reported
Interventions	1. Reduction and fixation with compression screw versus 2. McLaughlin nail plate versus 3. Bipolar hemiarthroplasty, Christiansen (lateral approach)
Outcomes	Follow‐up for 36 months. OUTCOMES COLLECTED BY TRIAL (a) Operative details: Duration of operation Number of blood transfusions (b) Complications related to type of operation: For both methods: re‐operations, superficial infection (c) Postoperative complications: Deep vein thrombosis Pulmonary embolism Pneumonia Cerebrovascular accident (d) Postoperative care outcomes: Mortality at 6, 12, 36 months Bed bound time (e) Anatomical restoration: none (f) Final outcome measures: Clinical results adapted from Love (pain and mobility) (g) Economic cost: none
Notes	Translation obtained for main points of article. Previous publication in Acta Orthop Scand 1984 reports better results in SHS group compared to nail‐plate in undisplaced and displaced fractures.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Not stated
Allocation concealment (selection bias)	Unclear risk	Not stated
Blinding (performance bias and detection bias) Were the assessors of pain and function at follow‐up blinded to the treatment allocation	High risk	No mention of blinding of assessors of pain and function

Tidermark 2003

Methods	Randomisation by: sealed envelopes.
Participants	One hospital, Karolinska Institute at Stockholm Söder Hospital, Sweden. 102 patients. (8 further patients were randomised but excluded: Six in the arthroplasty group were excluded as two patients had aortic valve stenosis, one patient had urinary tract infection, two patients changed their mind, and one had rheumatoid arthritis. For the internal fixation group, one had rheumatoid arthritis and one changed their mind) Characteristics of participants: Mean age: 79/81 years (range 70 to 96) Male: 20 (20%) Loss to follow‐up: 3 (3%) Inclusions: age 70 years and above, short portable mental status questionnaire of more than 2/10, displaced fracture of the femoral neck, not living in an institution, able to walk independently or with aids Exclusions: pathological fractures, fracture more than 24 hours from occurrence, rheumatoid arthritis, osteoarthritis
Interventions	1. Reduction and fixation with two cannulated screws versus 2. Exeter's modular stem cemented total hip replacement via an anterolateral approach
Outcomes	Follow‐up for 48 months OUTCOMES COLLECTED BY TRIAL (a) Operative details: length of surgery in minutes, operative blood loss, number of patients transfused (b) Complications related to type of operation: For internal fixation: fixation failure, early redisplacement, non‐union, avascular necrosis, fracture around implant For replacement arthroplasty: fracture around implant, dislocation Re‐operations Wound healing: superficial, infection, deep sepsis (c) Postoperative complications: deep vein thrombosis pulmonary embolism pressure sores myocardial infarction (d) Postoperative care outcomes: none (e) Anatomical restoration: none (f) Final outcome measures: Mortality at 4, 12, 24, 48 months Pain at 4, 12, 24, 48 months Activities of daily living score Health related quality of life questionnaire Walking ability (Charnley score) Movement of the hip (Charnley score) Failure to regain mobility (g) Economic cost: none
Notes	Additional information provided by trialists
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	'sealed envelope technique'
Allocation concealment (selection bias)	Unclear risk	'sealed envelope technique'
Blinding (performance bias and detection bias) Were the assessors of pain and function at follow‐up blinded to the treatment allocation	High risk	No mention of blinding of assessors of pain and function

van Dortmont 2000

Methods	Randomisation by: method not stated.
Participants	One hospital, Rotterdam, Netherlands. From April 1991 to January 1995 60 patients. Characteristics of participants: Mean age 84 (range 71 to 96) Male: 8 (13.3%) Loss to follow‐up: none reported. Inclusions: displaced intracapsular femoral neck fracture (Garden III‐IV), aged over 70, diagnosis of 'senile dementia' before admission Exclusions: not mentioned
Interventions	1. Reduction and fixation with 3 AO/ASIF screws versus 2. Unipolar Thompson hemiarthroplasty (cemented, anterior approach)
Outcomes	Follow‐up for 24 months Mean 16.5 months. OUTCOMES COLLECTED BY TRIAL (a) Operative details: Number days admission to surgery Length of surgery Operative blood loss (b) Complications related to type of operation: For internal fixation: adequacy of reduction Early and later secondary displacement, non‐union For both methods: Re‐operations, deep sepsis, superficial infection, haematoma, dehiscence (c) Postoperative complications: none (d) Postoperative care outcomes: (e) Anatomical restoration: none (f) Final outcome measures Mortality at 30 days, 4 and 12 months Ability to walk independently at 4 and 12 months Activities of daily living at 4 months (g) Economic cost: none
Notes	Study specifically for patients with senile dementia Confidence intervals for continuous outcomes supplied by the trialists
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Not stated
Allocation concealment (selection bias)	Unclear risk	Not stated
Blinding (performance bias and detection bias) Were the assessors of pain and function at follow‐up blinded to the treatment allocation	High risk	No mention of blinding of assessors of pain and function

van Vugt 1993

Methods	Randomisation by: method not stated.
Participants	One hospital, Leyenburg, The Hague, Netherlands. From 1 October 1985 to 1 November 1987 43 patients Characteristics of participants: Mean age: Fixation 75.3, arthroplasty 76 (range 71 to 80) Male: 18 (42%) Loss to follow‐up: 3 (7%) Inclusions: intracapsular fracture (Garden III‐IV), aged 71 to 80, good degree of independence according to Broos Exclusions: none stated
Interventions	1. Reduction and fixation with dynamic hip screw versus 2. Bipolar hemiarthroplasty, Stanmore variocup (anterolateral approach)
Outcomes	Follow‐up for 36 months OUTCOMES COLLECTED BY TRIAL (a) Operative details: Preoperative delay Operation time Perioperative blood loss (b) Complications related to type of operation: For internal fixation: delayed or non‐union, femoral head necrosis For replacement arthroplasty: loosening of prosthetic stem, acetabular protrusion, periarticular calcifications For both methods: Superficial and deep wound infection, haematoma, secondary intervention (c) Postoperative complications: Thromboembolic disease cardiovascular Pulmonary infection cerebrovascular accident psychiatric disease urinary tract infection pressure sore (d) Post‐operative care outcomes: Admission time (e) Anatomical restoration: none (f) Final outcome measures: Mortality at 1, 3, 6, 12, 24, 36 months Clinical effects of secondary intervention, loss of degree of independence, pain, and hip mobility (Shepherd) (g) Economic cost: none
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Not stated
Allocation concealment (selection bias)	Unclear risk	Not stated
Blinding (performance bias and detection bias) Were the assessors of pain and function at follow‐up blinded to the treatment allocation	High risk	No mention of blinding of assessors of pain and function

Characteristics of excluded studies [ordered by study ID]

Ir a:

estudios incluidos

Study	Reason for exclusion
Bray 1988	This study involved 34 patients, aged over 50 years, who were allocated to fixation with Knowles or Neufeld pins or replacement with a cemented bipolar hemiarthroplasty (type not specified). Follow‐up of patients averaged 19 months. Minimal data reported. Patients receiving hemiarthroplasties had statistically significantly longer anaesthetic and surgery time and greater blood loss. For length of hospital stay, average pain grade and average mobility grade there was no statistical difference between the two groups. The trial was excluded due to inadequate randomisation. Patients were allocated according to day of week and surgeon preference. Surgeon A elected on all even nights to use internal fixation, surgeon B on all odd nights to use hemiarthroplasty. In addition to the low numbers recruited five were lost to follow‐up.
El‐Abed 2005	This study was reported as a randomised comparison of 60 patients with an intracapsular fracture treated with a sliding hip screw and 62 patients treated with a hemiarthroplasty. The choice of treatment was by the preference of the attending surgeon on the day of admission. This study was excluded as it was considered as an inappropriate method of randomisation. (Additional information supplied by the trialists.)
Hunter 1969	Retrospective survey of 186 patients treated with internal fixation (Smith Petersen pin or pin and plate) or primary prosthesis (Judet or Moore). The author concluded that there was a lower morbidity and mortality rate following fixation. Excluded as not randomised.
Hunter 1974	Retrospective review of 200 patients treated with internal fixation (Thornton nail‐plate, Ken nail or Knowles pins) or prosthetic replacement (Thompson or Moore) . The author concluded that internal fixation gave lower morbidity, mortality and better results than prosthetic replacement. Excluded as not randomised.
Neander 2000	This was a randomised trial of 100 patients allocated to fixation with Olmed screws or replacement with a cemented BiMetric total hip replacement. Follow‐up was for 48 months. The authors concluded that there was an unacceptably high complication and re‐operation rate in the osteosynthesis group. Patients with total hip arthroplasty had fewer complications and a better clinical outcome after four years. This trial was excluded due to inadequate randomisation procedure. The first 20 patients were randomised with closed envelopes but the last 80 were allocated according to the day of week they were admitted (Monday to Thursday total hip replacement, Friday to Sunday reduction and fixation). The 17 year follow‐up of the trial was registered in 2011.
Parker 1992	This was a comparative study of 200 patients, 94 treated by internal fixation with two Garden screws and 104 with a hemiarthroplasty. Treatment was determined by the preference of the on call consultant, with some using internal fixation and the others arthroplasty. Results showed no significant difference in mortality. Internal fixation had a shorter hospital stay and a higher re‐admission and re‐operation rate. The study was excluded as it was not a randomised study.
Pathi 1989	This paper was described in the text as a ‘randomized trial of surgical treatment’. Of the 45 included patients, 10 patients were subsequently excluded because of loss to follow‐up. For the remaining 35 patients, 5 were treated with internal fixation with Smith‐Peterson nailing, 10 by internal fixation with Garden screws, 7 with a Thompson hemiarthroplasty and 13 with an Austin Moore hemiarthroplasty. There was limited description of patient characteristics, treatment methods and trial methodology. The only outcomes reported clearly were wound sepsis requiring antibiotics for two patients in the fixation group and five in the arthroplasty group. Nine cases of failure of surgical treatment were reported in the fixation group but it was unclear what constituted failure of treatment. Five wound haematomas and transient sciatic nerve paralysis were reported in the arthroplasty group. Re‐operations were not reported. Regain of mobility was reported at one year but the numbers were unclear. The study was excluded because of the inadequate trial methodology and reporting of the results.
Riley 1978	This study was only reported as an abstract. The study involved 151 patients allocated to Garden cross screw fixation or Austin Moore or Thompson prostheses. The author considered that prosthetic replacement gave significantly better results. The study was excluded as it provided no adequate data.
Rodriguez 1987	This was a comparative study of 301 patients following fixation with 3 AO screws or replacement with a cemented Thompson hemiarthroplasty. The authors reported a lower incidence of immediate postoperative mortality and infection in the fixation group. Excluded as not randomised.
Shafee 2007	This was described in the abstract of the paper as a prospective study of 50 patients who were treated with either an Austin Moore hemiarthroplasty or internal fixation with a sliding hip screws, Moor’s pins or cancellous screws. The full text of the article was not obtainable. The study was excluded because of lack of information and it was unlikely that it was a randomised trial.
Sikorski 1981	This was a randomised study of 218 patients. Patients were allocated to three arms ‐ fixation with Garden screws, a cemented Thompson using an anterior approach or to a cemented Thompson using a posterior approach. Patients in the fixation arm whose fractures were irreducible in theatre were then randomised to an anterior or posterior Thompson. These were then analysed as a fourth group with no details of which surgical approach they received. Interpreting results was confusing. Follow‐up of patients was for 24 months or until revision. Operative mortality in the irreducible group was reported as unacceptable. The authors concluded that the anterior hemiarthroplasty was the safest treatment . This study was excluded due to its poor methodological quality. The comparison between anterior and posterior approach is being considered in a separate Cochrane review.
Stewart 1984	Retrospective study comparing internal fixation with Pugh's nail and plate with a Thompson hemiarthroplasty in 100 patients. The authors found results comparable at one year but failure rate was higher following internal fixation. Excluded because the study was not randomised.

Data and analyses

Open in table viewer

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
Open in figure viewer Analysis 1.1 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 1 Length of surgery ( in minutes).
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
Open in figure viewer Analysis 1.2 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 2 Operative blood loss (in millilitres).
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]
Open in figure viewer Analysis 1.3 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 3 Number of patients transfused.
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]
Open in figure viewer Analysis 1.4 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 4 Mean units blood transfused.
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]
Open in figure viewer 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 5 Non‐union of fracture within follow‐up period (includes early displacement).
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]
Open in figure viewer Analysis 1.6 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 6 Avascular necrosis.
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
Open in figure viewer Analysis 1.7 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 7 Dislocation of prosthesis.
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
Open in figure viewer Analysis 1.8 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 8 Loosening of prosthesis.
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]
Open in figure viewer Analysis 1.9 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 9 Acetabular wear (as defined by each study).
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]
Open in figure viewer Analysis 1.10 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 10 Fracture below/around implant.
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]
Open in figure viewer Analysis 1.11 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 11 Re‐operations minor (e.g. removal of fixation, dislocation of arthroplasty).
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]
Open in figure viewer Analysis 1.12 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 12 Re‐operations moderate (e.g. fixation to arthroplasty, drainage, girdlestone).
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]
Open in figure viewer Analysis 1.13 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 13 Re‐operations major (e.g. revision arthroplasty, hemiarthroplasty to THR).
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]
Open in figure viewer Analysis 1.14 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 14 Total re‐operation rate (within follow‐up period of study).
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]
Open in figure viewer Analysis 1.15 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 15 Superficial wound infection.
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]
Open in figure viewer Analysis 1.16 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 16 Deep wound infection.
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]
Open in figure viewer Analysis 1.17 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 17 Pneumonia.
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]
Open in figure viewer Analysis 1.18 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 18 Deep vein thrombosis.
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]
Open in figure viewer Analysis 1.19 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 19 Pulmonary embolism.
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]
Open in figure viewer Analysis 1.20 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 20 Thromboembolic complications combined.
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]
Open in figure viewer Analysis 1.21 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 21 Congestive cardiac failure/heart failure.
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]
Open in figure viewer Analysis 1.22 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 22 Myocardial infarction.
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]
Open in figure viewer Analysis 1.23 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 23 Stroke (cerebrovascular accident).
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
Open in figure viewer Analysis 1.24 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 24 Confusional state.
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]
Open in figure viewer Analysis 1.25 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 25 Gastrointestinal complications.
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]
Open in figure viewer Analysis 1.26 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 26 Pressure sores.
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]
Open in figure viewer Analysis 1.27 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 27 Total medical complications (as defined in each study).
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
Open in figure viewer Analysis 1.28 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 28 Length of hospital stay (in days).
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]
Open in figure viewer Analysis 1.29 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 29 Mortality 30 days.
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]
Open in figure viewer Analysis 1.30 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 30 Mortality up to 3 to 6 months.
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]
Open in figure viewer Analysis 1.31 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 31 Mortality up to 12 months.
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]
Open in figure viewer Analysis 1.32 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 32 Mortality up to 24 to 48 months.
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]
Open in figure viewer Analysis 1.33 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 33 Mortality 10 years.
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]
Open in figure viewer Analysis 1.34 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 34 Residual pain at 1 year.
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]
Open in figure viewer Analysis 1.35 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 35 Residual pain at 1 year (subgrouped by cemented versus uncemented).
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]
Open in figure viewer Analysis 1.36 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 36 Mean pain score at 1 to 2 years.
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]
Open in figure viewer 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).
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]
Open in figure viewer Analysis 1.38 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 38 Pain at 2 to 3 years.
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]
Open in figure viewer Analysis 1.39 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 39 Failure to return to same residence at final follow‐up.
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]
Open in figure viewer Analysis 1.40 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 40 Failure to regain mobility.
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
Open in figure viewer Analysis 1.41 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 41 Harris hip score (at 1 year).
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
Open in figure viewer Analysis 1.42 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 42 Hip rating questionnaire at 1 year.
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
Open in figure viewer Analysis 1.43 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 43 Hip scores (at 1 year).
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
Open in figure viewer Analysis 1.44 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 44 Mean Eq‐5d score (at 1 year).
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
Open in figure viewer Analysis 1.45 Comparison 1 Internal fixation versus arthroplasty (all types), Outcome 45 Barthel index score of below 95 at 1 year.
45.1 Fixation versus hemiarthroplasty	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Open in table viewer

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
Open in figure viewer Analysis 2.1 Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 1 Length of surgery (in minutes).
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
Open in figure viewer Analysis 2.2 Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 2 Operative blood loss (in millilitres).
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]
Open in figure viewer Analysis 2.3 Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 3 Number of patients transfused.
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
Open in figure viewer Analysis 2.4 Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 4 Re‐operations minor ( eg fixation‐ removal of metalwork, dislocation of hemiarthroplasty).
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
Open in figure viewer Analysis 2.5 Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 5 Re‐operations moderate (eg fixation to hemiarthroplasty or total hip replacement, drainage, girdlestone).
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
Open in figure viewer Analysis 2.6 Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 6 Re‐operations major (eg revision hemiarthroplasty or conversion to total hip replacement).
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
Open in figure viewer Analysis 2.7 Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 7 Total re‐operation rate (within follow‐up period of study).
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]
Open in figure viewer Analysis 2.8 Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 8 Superficial wound infection.
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
Open in figure viewer Analysis 2.9 Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 9 Deep wound infection.
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]
Open in figure viewer Analysis 2.10 Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 10 Length of hospital stay (in days).
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]
Open in figure viewer Analysis 2.11 Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 11 Mortality at 30 days.
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]
Open in figure viewer Analysis 2.12 Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 12 Mortality up to 3 to 6 months.
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]
Open in figure viewer Analysis 2.13 Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 13 Mortality up to 12 months.
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]
Open in figure viewer Analysis 2.14 Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 14 Mortality 24 to 48 months.
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]
Open in figure viewer Analysis 2.15 Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 15 Mortality 10 years.
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]
Open in figure viewer Analysis 2.16 Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 16 Pain at one year.
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]
Open in figure viewer Analysis 2.17 Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 17 Failure to return to same residence at final follow‐up.
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]
Open in figure viewer Analysis 2.18 Comparison 2 Internal fixation versus hemiarthroplasty, Outcome 18 Failure to regain mobility.
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]

Open in table viewer

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
Open in figure viewer Analysis 3.1 Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 1 Length of surgery (in minutes).
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
Open in figure viewer Analysis 3.2 Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 2 Operative blood loss (in millilitres).
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]
Open in figure viewer Analysis 3.3 Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 3 Number of patients transfused.
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
Open in figure viewer Analysis 3.4 Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 4 Re‐operations minor (Fixation removal of metalwork, dislocation of THR).
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
Open in figure viewer Analysis 3.5 Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 5 Re‐operations moderate (Fixation to hemiarthroplasty or THR, drainage, girdlestone).
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
Open in figure viewer Analysis 3.6 Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 6 Re‐operations major (revision THR).
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
Open in figure viewer Analysis 3.7 Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 7 Total re‐operation rate (within follow‐up period of study).
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]
Open in figure viewer Analysis 3.8 Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 8 Superficial wound infection.
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
Open in figure viewer Analysis 3.9 Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 9 Deep wound infection.
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
Open in figure viewer Analysis 3.10 Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 10 Hospital stay (days).
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]
Open in figure viewer Analysis 3.11 Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 11 Mortality up to 2 to 4 months.
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]
Open in figure viewer Analysis 3.12 Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 12 Mortality at 12 to 18 months.
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]
Open in figure viewer Analysis 3.13 Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 13 Mortality at 24 months.
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
Open in figure viewer Analysis 3.14 Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 14 Mortality at 4 years.
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]
Open in figure viewer Analysis 3.15 Comparison 3 Internal fixation versus Total Hip Replacement, Outcome 15 Pain at 1 year.
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]

Figure 1

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 2

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.1

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.2

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.3

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.4

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

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

Analysis 1.5

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.6

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.7

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.8

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.9

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.10

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.11

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.12

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.13

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.14

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.15

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.16

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.17

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.18

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.19

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.20

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.21

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.22

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.23

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.24

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.25

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.26

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.27

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.28

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.29

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.30

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.31

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.32

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.33

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.34

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.35

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.36

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

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).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.38

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.39

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.40

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.41

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.42

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.43

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.44

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.45

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.1

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.2

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.3

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.4

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.5

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.6

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.7

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.8

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.9

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.10

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.11

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.12

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.13

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.14

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.15

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.16

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.17

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.18

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.1

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.2

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.3

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.4

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.5

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.6

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.7

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.8

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.9

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.10

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.11

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.12

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.13

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.14

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.15

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

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.

Table 1. Methodological quality assessment scheme

Ir a la tabla de la revisión

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

Table 2. Methodological quality assessment results (see Table 1 for criteria)

Ir a la tabla de la revisión

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]

Comparison 1. Internal fixation versus arthroplasty (all types)

Ir a la tabla de la revisión

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]

Comparison 2. Internal fixation versus hemiarthroplasty

Ir a la tabla de la revisión

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]

Comparison 3. Internal fixation versus Total Hip Replacement

Ir a la tabla de la revisión

	Idioma de la Revisión Cochrane Escoja su idioma de preferencia para las revisiones Cochrane y otros contenidos. Las secciones sin una traducción aparecerán en inglés.

	Idioma de la web Escoja su idioma de preferencia para la web de la Biblioteca Cochrane.

Idioma de la Revisión Cochrane

Idioma de la web

Referencias

Referencias de los estudios incluidos en esta revisión

Blomfeldt 2005 {published data only}

Davison 2001 {published data only}

Frihagen 2007 {published data only}

Jensen 1984 {published and unpublished data}

Johansson 2002 {published data only}

Jonsson 1996 {published data only}

Mouzopoulos 2008 {published data only}

Neander 1997 {published data only}

Parker 2002 {published and unpublished data}

Puolakka 2001 {published data only}

Roden 2003 {published data only}

Rogmark 2002 {published and unpublished data}

Skinner 1989 {published data only}

Soreide 1979 {published data only}

STARS 2006 {published data only}

Svenningsen 1985 {published data only}

Tidermark 2003 {published data only}

van Dortmont 2000 {published data only}

van Vugt 1993 {published data only}

Referencias de los estudios excluidos de esta revisión

Bray 1988 {published data only}

El‐Abed 2005 {published data only}

Hunter 1969 {published data only}

Hunter 1974 {published data only}

Neander 2000 {published and unpublished data}

Parker 1992 {published data only}

Pathi 1989 {published data only}

Riley 1978 {published data only}

Rodriguez 1987 {published data only}

Shafee 2007 {published data only}

Sikorski 1981 {published data only}

Stewart 1984 {published data only}

Referencias adicionales

Bhandari 2003

Higgins 2003

Lefebvre 2009

Lu‐Yao 1994

Parker 2001

Parker 2010

Rogmark 2006

Referencias de otras versiones publicadas de esta revisión

Masson 2002

Parker 2006

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Characteristics of excluded studies [ordered by study ID]

Data and analyses

Copiar o descargar referencia

Idioma de la Revisión Cochrane

Idioma de la web

Instituciones a las que se accedió previamente

Usuarios institucionales

Instituciones a las que se accedió previamente

Otras opciones de acceso