Cochrane · systematic review · CD013404
Surgical interventions for treating intracapsular hip fractures in older adults: a network meta‐analysis
Lewis, SR, Macey, R, Stokes, J, et al. · Cochrane Database of Systematic Reviews · 2022 · Cochrane Library
Bone, Joint and Muscle TraumaAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
35
current version
GRADE rated
29
No studies
3
Included studies
NR
No studies 3 · 8.6%Ungraded 3 · 8.6%Very low 25 · 71.4%Low 4 · 11.4%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Certainty of the effects and network estimates of surgical interventions for treating intracapsular hip fractures in older adults: mortality at 12 months
Population: older adults (> 60 years of age) with intracapsular hip fractures; most fractures in the included studies were displaced
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Total studies: 56 Total participants: 9419 | no estimate extracted | 56 participants | Ungraded |
Dynamic fixed angle plate (2 RCTs; 246 participants)a | RR 1.02 [0.79, 1.32] | 2 studies · 246 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Uncemented first‐generation bipolar hemiarthroplasty (No direct evidence, indirect evidence only) | RR 1.42 [0.82, 2.45] | NR | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Uncemented modern bipolar hemiarthroplasty (No direct evidence, indirect evidence only) | RR 1.37 [1.02, 1.85] | NR | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Cemented modern bipolar hemiarthroplasty (6 RCTs; 771 participants)a | RR 1.14 [0.92, 1.42] | 6 studies · 771 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Uncemented first‐generation unipolar hemiarthroplasty (4 RCTs; 668 participants)a | RR 1.06 [0.86, 1.3] | 4 studies · 668 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Uncemented modern unipolar hemiarthroplasty (4 RCTs; 891 participants)a | RR 1.16 [0.93, 1.45] | 4 studies · 891 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Total hip arthroplasty (single articulation) (2 RCTs; 225 participants)a | RR 1.62 [1.13, 2.32] | 2 studies · 225 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Dual‐mobility total hip arthroplasty (No direct evidence, indirect evidence only) | RR 1.07 [0.37, 3.14] | NR | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Pins (No direct evidence, indirect evidence only) | RR 1.03 [0.78, 1.37] | NR | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Screws (3 RCTs; 152 participants)a | RR 1.09 [0.9, 1.33] | 3 studies · 152 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Non‐operative treatment (No direct evidence, indirect evidence only) | RR 1.1 [0.59, 2.07] | NR | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Cemented modern unipolar hemiarthroplasty | no estimate extracted | NR | No studies |
Certainty of the effects and network estimates of surgical interventions for treating intracapsular hip fractures in older adults: health‐related quality of life at 12 months
Population: older adults (> 60 years of age) with intracapsular hip fractures; most fractures in the included studies were displaced
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Total studies: 13 Total participants: 2744 | no estimate extracted | 13 participants | Ungraded |
Dynamic fixed angle plate (No direct evidence, indirect evidence only) | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision, indirectness |
Uncemented modern bipolar hemiarthroplasty (No direct evidence, indirect evidence only) | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision, indirectness |
Cemented modern bipolar hemiarthroplasty (1 RCT; 120 participants)a | no estimate extracted | 1 study · 120 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Uncemented modern unipolar hemiarthroplasty (1 RCT; 201 participants)a | no estimate extracted | 1 study · 201 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Total hip arthroplasty (single articulation) (1 RCT; 120 participants)a | no estimate extracted | 1 study · 120 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Screws (1 RCT; 60 participants)a | no estimate extracted | 1 study · 60 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Non‐operative treatment (No direct evidence, indirect evidence only) | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision, indirectness |
Cemented modern unipolar hemiarthroplasty | no estimate extracted | NR | No studies |
Certainty of the effects and network estimates of surgical interventions for treating intracapsular hip fractures in older adults: unplanned return to theatre
Population: older adults (> 60 years of age) with intracapsular hip fractures; most fractures in the included studies were displaced
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Total studies: 53 Total participants: 9493 | no estimate extracted | 53 participants | Ungraded |
Dynamic fixed angle plate (1 RCT; 190 participants)a | RR 4.63 [2.94, 7.3] | 1 study · 190 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Uncemented first‐generation bipolar hemiarthroplasty (No direct evidence, indirect evidence only) | RR 1.36 [0.1, 17.63] | NR | Very low Downgraded: risk of bias, imprecision, indirectness |
Uncemented modern bipolar hemiarthroplasty (No direct evidence, indirect evidence only) | RR 1.92 [0.75, 4.95] | NR | Very low Downgraded: risk of bias, imprecision, indirectness |
Cemented modern bipolar hemiarthroplasty (3 RCTs; 485 participants)a | RR 1.4 [0.84, 2.35] | 3 studies · 485 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Uncemented first‐generation unipolar hemiarthroplasty (1 RCT; 400 participants)a | RR 1.43 [0.85, 2.4] | 1 study · 400 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Uncemented modern unipolar hemiarthroplasty (3 RCTs; 491 participants)a | RR 1.83 [0.52, 6.41] | 3 studies · 491 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Total hip arthroplasty (single articulation) (3 RCTs; 306 participants)a | RR 1.45 [0.87, 2.42] | 3 studies · 306 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Dual‐mobility total hip arthroplasty (No direct evidence, indirect evidence only) | RR 0.64 [0.02, 17.67] | NR | Very low Downgraded: risk of bias, imprecision, indirectness |
Pins (No direct evidence, indirect evidence only) | RR 4.16 [2.53, 6.84] | NR | Very low Downgraded: risk of bias, imprecision, indirectness |
Screws (2 RCTs; 278 participants)a | RR 5.04 [3.25, 7.82] | 2 studies · 278 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Non‐operative treatment (No direct evidence, indirect evidence only) | RR 5.41 [1.8, 16.26] | NR | Very low Downgraded: risk of bias, imprecision, indirectness |
Cemented modern unipolar hemiarthroplasty | no estimate extracted | NR | No studies |