Twenty studies (3,109 patients) were included in the review. Sample sizes ranged from 43 to 455 patients. Follow up ranged from 12 to 156 months.
Complications: Arthroplasty was associated with a statistically significant increased risk of deep wound infection compared to internal fixation (RR 1.82, 95% CI 1.03 to 3.21; 15 studies). There was no statistically significant difference in the risk of other general medical complications (superficial wound infection, pneumonia, deep vein thrombosis, pulmonary embolism, thromboembolic complications combined, cardiac failure, myocardial infarction, stroke, gastrointestinal complications, pressure sores) between arthroplasty and internal fixation.
Arthroplasty was associated with a statistically significant reduced risk of surgical complications at two years postoperatively compared to all types of internal fixation (RR 0.31, 95% CI 0.17 to 0.55; 10 studies). However, there was evidence of statistically significant heterogeneity (I2=76%). Subgroup analyses showed that arthroplasty was also associated with a statistical significant decreased risk of surgical complications compared to multiple screws internal fixation (RR 0.28, 95% CI 0.15 to 0.52; nine studies). However, again there was evidence of statistically significant heterogeneity (I2=78%). There was no statistically significant difference in risk of surgical complications at two years between arthroplasty and compression screw and plate internal fixation (one study).
Reoperation: Arthroplasty was associated with a statistically significant lower risk reoperation at one year (RR 0.29, 95% CI 0.17 to 0.49; three studies), two years (RR 0.22, 95% CI 0.17 to 0.28; 10 studies) and five years (RR 0.20, 95% CI 0.12 to 0.32; two studies) postoperatively compared to all types of internal fixation.
Mortality: There was no statistically significant difference in risk of mortality at one month postoperatively (10 studies), four to six months postoperatively (14 studies), one year postoperatively (16 studies) and at two years (13 studies) between arthroplasty and all types of internal fixation, arthroplasty and multiple screws internal fixation and arthroplasty and compression screw and plate internal fixation.