. 2025 Jul 29;20:718. doi: 10.1186/s13018-025-06144-w

Table 3.

Table of main findings with grades of evidence

Total arthroplasty compared to partial arthroplasty for patients with displaced femoral neck fractures
Patient or population: patients > 50 yo with displaced femoral neck fractures Context: Hospital Intervention: total hip arthroplasty Comparison: hemiarthoplasty
Outcome Number of participants (studies)	Relative effect (CI 95%)	Potential XXXemiarth effects (CI 95%)	Certainty of evidence	Results
Hemiarthoplasty	Total hip arthroplasty	Difference
Revision Rate Nº of participants = 4078 (22 RCTs)	RR 0.67 (0.48 to 0.93)	9.3%	6.2% (4.5 to 8.6)	3.1% (4.8 to 0.6)	⨁⨁⨁◯ Moderate^a	Total arthroplasty results in a reduction in the revision rate.
Mortality Nº of participants = 4618 (25 RCTs)	RR 0.94 (0.81 to 1.09)	19.5%	18.4% (15.8 to 21.3)	1.2% (3.7 to 1.8)	⨁⨁⨁⨁ High	Total hip arthroplasty shows no difference in the mortality rate.
Function (HHS and Oxford) Nº of participants = 963 (12 RCTs)	-	The average function was 71.9 points	-	MD 7.49 more (1.4 to 13.7)	⨁◯◯◯ Very low^{a, c}	Total hip arthroplasty showed better early function, but the evidence is very uncertain. SMD = 0.59 (95% CI 0.04 to 1.08).
Quality of life (EuroQol-5 Dimensions) № of participants: 1240 (6 RCTs)	-	The mean quality of life ranged from 0.53 to 0.80 units	-	MD 0.05 units more (0.03 more to 0.08 more)	⨁⨁⨁⨁ High	Total hip arthroplasty results in a better quality of life.
Dislocation rate № of participants: 5038 (29 RCTs)	RR 1.25 (0.81 to 1.91)	4,4%	5.5% (3.5 to 8.3)	1,1% mais (0,8 menos para 4 mais)	⨁⨁◯◯ Low^{d, e}	Total hip arthroplasty shows no difference in the rate of prosthetic dislocation.
Surgical time № of participants: 1493 (16 RCTs)	-	The mean surgical time ranged from 35 to 125.3 min	-	MD 20.46 min (12.12 to more)	⨁⨁◯◯ Low^f	Total hip arthroplasty may increase surgical time slightly.
Periprosthetic Fracture Rate № of participants: 2190 (9 RCTs)	RR 1.13 (0.74 to 1.72)	3.5%	3.9% (2.6 para 6)	0.5% (0,9 to 2,5)	⨁⨁⨁◯ Moderate^g	Total hip arthroplasty does not show a difference in the periprosthetic fracture rate.
Periprosthetic Infection Rate № of participants: 1650 (13 RCTs)	RR 1.54 (0.77 to 3.08)	1.5%	2.3% (1.1 to 4.5)	0.8% (0.3 to 3.1)	⨁⨁⨁◯ Moderate^g	Total hip arthroplasty does not show a difference in the periprosthetic infection rate.

Total arthroplasty compared to partial arthroplasty for patients with displaced femoral neck fractures

Patient or population: patients > 50 yo with displaced femoral neck fractures

Context: Hospital

Intervention: total hip arthroplasty

Comparison: hemiarthoplasty

Outcome

Number of participants (studies)

Relative effect

(CI 95%)

Potential XXXemiarth effects (CI 95%)

Certainty of evidence

Results

Hemiarthoplasty

Total hip arthroplasty

Difference

Revision Rate

Nº of participants = 4078

(22 RCTs)

RR 0.67

(0.48 to 0.93)

9.3%

6.2%

(4.5 to 8.6)

3.1%

(4.8 to 0.6)

⨁⨁⨁◯

Moderate^a

Total arthroplasty results in a reduction in the revision rate.

Mortality

Nº of participants = 4618

(25 RCTs)

RR 0.94

(0.81 to 1.09)

19.5%

18.4%

(15.8 to 21.3)

1.2%

(3.7 to 1.8)

⨁⨁⨁⨁

High

Total hip arthroplasty shows no difference in the mortality rate.

Function (HHS and Oxford)

Nº of participants = 963

(12 RCTs)

The average function was 71.9 points

MD 7.49 more

(1.4 to 13.7)

⨁◯◯◯

Very low^{a, c}

Total hip arthroplasty showed better early function, but the evidence is very uncertain.

SMD = 0.59 (95% CI 0.04 to 1.08).

Quality of life

(EuroQol-5 Dimensions)

№ of participants: 1240

(6 RCTs)

The mean quality of life ranged from 0.53 to 0.80 units

MD 0.05 units more (0.03 more to 0.08 more)

⨁⨁⨁⨁

High

Total hip arthroplasty results in a better quality of life.

Dislocation rate

№ of participants: 5038

(29 RCTs)

RR 1.25

(0.81 to 1.91)

4,4%

5.5%

(3.5 to 8.3)

1,1% mais

(0,8 menos para 4 mais)

⨁⨁◯◯

Low^{d, e}

Total hip arthroplasty shows no difference in the rate of prosthetic dislocation.

Surgical time

№ of participants: 1493

(16 RCTs)

The mean surgical time ranged from 35 to 125.3 min

MD 20.46 min

(12.12 to more)

⨁⨁◯◯

Low^f

Total hip arthroplasty may increase surgical time slightly.

Periprosthetic Fracture Rate

№ of participants: 2190

(9 RCTs)

RR 1.13

(0.74 to 1.72)

3.5%

3.9%

(2.6 para 6)

0.5%

(0,9 to 2,5)

⨁⨁⨁◯

Moderate^g

Total hip arthroplasty does not show a difference in the periprosthetic fracture rate.

Periprosthetic Infection Rate

№ of participants: 1650

(13 RCTs)

RR 1.54

(0.77 to 3.08)

1.5%

2.3%

(1.1 to 4.5)

0.8%

(0.3 to 3.1)

⨁⨁⨁◯

Moderate^g

Total hip arthroplasty does not show a difference in the periprosthetic infection rate.

* The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk of the comparator group and the relative effect of the intervention (and its 95% CI)

CI: Confidence interval; MD: Mean difference; RCT: Randomized clinical trial; RR: Relative risk

GRADE Working Group grades of evidence

High certainty: High confidence that the true effect is close to the estimate

Moderate certainty: Moderate confidence in the effect estimate: the actual effect is likely to be close to the effect estimate, but there is a possibility that it will be substantially different

Low certainty: Confidence in the effect estimate is limited: the true effect may be substantially different from the effect estimate

Very low certainty: Very little confidence in the effect estimate: The true effect is likely to be substantially different from the effect estimate