{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,26]],"date-time":"2026-04-26T17:36:27Z","timestamp":1777224987132,"version":"3.51.4"},"reference-count":52,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2020,12,22]],"date-time":"2020-12-22T00:00:00Z","timestamp":1608595200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Currently, there are 2 mainstream treatments for displaced femoral neck fracture, including internal fixation and arthroplasty. However, there are still some controversial problems as to which treatment should be primarily chosen.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>The relevant studies comparing arthroplasty with internal fixation were searched in the databases of PubMed, Embase, and Cochrane Library. Finally, 31 relevant randomized controlled trials were included in this meta-analysis. The quality of studies was evaluated and meta-analyses were performed using RevMan 5.3 software. We also assessed the heterogeneity among studies and publication bias via the I-squared index and forest plots.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>There was no significant difference between arthroplasty and internal fixation groups in patient mortality at both short-term and long-term points. However, patients treated with arthroplasty showed significantly lowered risks of reoperation both at short-term (5.6% vs 31.5%; relative risks (RR) \u200a=\u200a0.19; 95% CI, 0.13\u20130.28; <jats:italic toggle=\"yes\">P<\/jats:italic>\u200a&lt;\u200a.00001) and long-term follow-up (9.5% vs 45.9%; RR\u200a=\u200a0.23; 95% CI, 0.17\u20130.33; <jats:italic toggle=\"yes\">P<\/jats:italic>\u200a&lt;\u200a.00001). Similarly, arthroplasty-treated patients demonstrated a significant decrease in the risk of postoperation complications at short-term (10.3% vs 34.4%; RR\u200a=\u200a0.37, 95% CI, 0.24\u20130.57; <jats:italic toggle=\"yes\">P<\/jats:italic>\u200a&lt;\u200a.00001) and long-term follow-up (11.7% vs 42.5%; RR\u200a=\u200a0.30, 95% CI, 0.16\u20130.57; <jats:italic toggle=\"yes\">P<\/jats:italic>\u200a&lt;\u200a.0002). Besides, patients in the arthroplasty group were associated with better alleviation of pain postoperation (18.3% vs 31.1%; RR\u200a=\u200a0.50, 95% CI, 0.33\u20130.78; <jats:italic toggle=\"yes\">P<\/jats:italic>\u200a=\u200a.002).<\/jats:p>\n            <jats:p>In trial sequence analyses, all cumulative Z curves except that of mortality crossed the trial sequential monitoring boundaries and conventional boundaries, and required information size has been reached.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Arthroplasty leads to a lower rate of reoperation, a reduced risk of complications, and a better alleviation of postoperation pain both at short-term and long-term follow-up. Most importantly, and according to trial sequence analyses, more than enough evidence has been achieved that arthroplasty does show better outcomes than internal fixation in terms of reoperation rate, complications, and postoperation pain.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Level of Evidence:<\/jats:title>\n            <jats:p>Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/oi9.0000000000000087","type":"journal-article","created":{"date-parts":[[2020,12,22]],"date-time":"2020-12-22T16:07:24Z","timestamp":1608653244000},"page":"e087","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":14,"title":["A systematic review and meta-analysis comparing arthroplasty and internal fixation in the treatment of elderly displaced femoral neck fractures"],"prefix":"10.1097","volume":"4","author":[{"given":"Junhao","family":"Deng","sequence":"first","affiliation":[{"name":"Department of Orthopaedics"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guoqi","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Chinese PLA General Hospital, Beijing"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jia","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Song","family":"Wang","sequence":"additional","affiliation":[{"name":"Medical College, Nankai University, Tianjin"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miao","family":"Li","sequence":"additional","affiliation":[{"name":"Key Laboratory of Chemical Genomics, Shenzhen Graduate School, Peking University, Shenzhen"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaohong","family":"Yin","sequence":"additional","affiliation":[{"name":"Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, P.R. China."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Licheng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peifu","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics"},{"name":"Medical College, Nankai University, Tianjin"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2021,3]]},"reference":[{"key":"R1-20240807","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1007\/s00198-004-1627-0","article-title":"An estimate of the worldwide prevalence, mortality and disability associated with hip fracture","volume":"11","author":"Johnell","year":"2004","journal-title":"Osteoporos Int."},{"key":"R2-20240807","doi-asserted-by":"crossref","first-page":"1726","DOI":"10.1007\/s00198-006-0172-4","article-title":"An estimate of the worldwide prevalence and disability associated with osteoporotic fractures","volume":"12","author":"Johnell","year":"2006","journal-title":"Osteoporos Int."},{"key":"R3-20240807","doi-asserted-by":"crossref","first-page":"1761","DOI":"10.1016\/S0140-6736(02)08657-9","article-title":"Epidemiology and outcomes of osteoporotic fractures","volume":"359","author":"Cummings","year":"2002","journal-title":"Lancet."},{"key":"R4-20240807","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1097\/00003086-200109000-00027","article-title":"Hip fracture in elderly patients: outcomes for function, quality of life, and type of residence","volume":"390","author":"van Balen","year":"2001","journal-title":"Clin Orthop Relat Res."},{"key":"R5-20240807","doi-asserted-by":"crossref","first-page":"2691","DOI":"10.1007\/s11999-013-3020-9","article-title":"Treatment and displacement affect the reoperation rate for femoral neck fracture","volume":"471","author":"Murphy","year":"2013","journal-title":"Clin Orthop Relat Res."},{"key":"R6-20240807","doi-asserted-by":"crossref","first-page":"1673","DOI":"10.2106\/00004623-200309000-00004","article-title":"Internal fixation compared with arthroplasty for displaced fractures of the femoral neck. 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