Author summary
An increase in the rate of mortality at thirty days after primary hemiarthroplasty compared with that after primary internal fixation was observed, although the difference was not statistically significant and did not persist beyond three months. The absolute difference in perioperative mortality between the two groups was small.
The rate of loss of fixation or reduction after internal fixation was higher than dislocations following unipolar, bipolar or total hip arthroplasty.
An anterior operative approach for arthroplasty consistently was associated with a lower rate of mortality at two months than was a posterior approach.
Although internal fixation was associated with a higher rate of failure, it offers patients the chance to regain normal function of the hip. Long-term follow-up of patients who have been managed with internal fixation is needed to assess whether the chance of long-term benefit is sufficient to offset the greater chance of failure in the first two years after surgery.
1 Mortality and reoperation rates were calculated from 5 studies that were comparable in terms of age, sex, and functional status before the fracture.
2 Only studies with the follow-up more than seven years were evaluated (n = 2). Data for the reoperation rate more than three years after fracture was only available for patients following an arthroplasty.
