Outcomes of total hip arthroplasty, as a salvage procedure, following failed internal fixation of intracapsular fractures of the femoral neck: a systematic review and meta-analysis

The management of intracapsular femoral neck fractures in independently mobile patients remains controversial. Successful fixation obviates the limitations of arthroplasty for this group of patients, however with fixation failure rates as high as 30%, the outcome of revision surgery to salvage total hip replacement (THR) must be considered. We carried out this review to determine the outcome of salvage THR and how this compares to primary THR for fracture. We performed a PRISMA compliant systematic review using the PubMed, EMBASE and Cochrane libraries databases. A meta-analysis was performed when possible and a narrative synthesis when a meta-analysis was not possible. Our analysis revealed a significantly increased risk of complications including deep infection, early dislocation and peri-prosthetic fracture when salvage THR was compared with primary THR for an intracapsular femoral neck fracture (overall risk ratio of 3.15). Functional outcomes assessment using EQ5D were not significantly different (p=0.3).