Fractures of the thigh bone (femur) near the hip joint (termed intracapsular) may be treated by fixing the fracture (with screws or pins), or alternatively replacing the top of the femur at the hip joint (femoral head) with an artificial hip joint (arthroplasty).
Nineteen trials, of which two were newly included in this update, involving 3044 participants, were included in this review. Some trials had weak methods, which required a more cautious interpretation of their results. There were many different types of devices and methods used to place these devices for both treatments in the included trials.
We found that each treatment has its own specific complications. Realigning the bones and fixing the fracture (reduction and internal fixation) is a shorter operation with less blood loss. However, people having internal fixation are more likely to need another operation than those treated with joint replacement (40% versus 11%). The reason for this is mainly from a failure of the bone to heal in those cases treated with fixation. No definite differences were found between the two treatment groups in the numbers of patients who had died by various follow-up times. People who had a replacement with an artificial hip joint that was fixed in place with cement seemed to have less residual pain and better function related to using the hip than those whose fracture was fixed. There is not enough evidence to be sure whether fixation of the bone or replacement with an artificial hip is best for treating fractures of the thigh bone near the hip joint.