Association of Hardware Removal with Secondary Osteonecrosis Following Femoral Neck Fractures: a Systematic Review and Meta-analysis

Overview

Journal J Orthop Surg Res

Publisher Biomed Central

Specialty Orthopedics

Date 2023 Dec 7

PMID 38057793

Authors

Qilong Jiang

Yu Deng

Yang Liu

Zhi Zhao

Yu Chen

Xinwen Bai

Hao Hong

Affiliations

Soon will be listed here.

Abstract

Background: It has been controversial that whether hardware removal will increase the risk of osteonecrosis of femoral head (ONFH) in fracture-healed patients who underwent internal fixation for femoral neck fractures (FNFs). This meta-analysis aimed to clarify the association of hardware removal with secondary hardware removal-induced ONFH (HR-ONFH).

Methods: Four electronic databases (PubMed, Embase, Web of Science, Cochrane Library) were searched for eligible studies published up to March 10, 2023. Studies reporting the relative risk of hardware status (i.e., risk rate, odds ratio [OR], or hazard ratio [HR]) were included. Newcastle-Ottawa scale (NOS) was used to assess risk of bias of included observational studies. Review Manager software was used to pool ORs and adjusted ORs.

Results: Five studies were included into quantitative synthesis. Hardware removal was associated with a reduced risk of HR-ONFH in the synthesis of crude odds ratios (OR, 0.62, 95% CI 0.39-0.96). In the synthesis of adjusted odds ratios, hardware removal was associated with an increased risk of HR-ONFH (OR, 1.76, 95% CI 1.23-2.51).

Conclusion: This study demonstrates that hardware removal was associated with an increased incidence of HR-ONFH in fracture-healed patients who underwent internal fixation due to FNFs.

Citing Articles

Causal relationship between osteoporosis, bone mineral density, and osteonecrosis: a bidirectional two-sample Mendelian randomization study.

Zhang C, Yu H, Miao Y, Wei B J Transl Med. 2025; 23(1):226.

PMID: 40001090 PMC: 11863788. DOI: 10.1186/s12967-024-06030-9.

Letter to the editor concerning "Association of hardware removal with secondary osteonecrosis following femoral neck fractures: a systematic review and meta-analysis".

Shao W, Wang P, Wang B, Zou L, Feng Y J Orthop Surg Res. 2024; 19(1):45.

PMID: 38191457 PMC: 10773005. DOI: 10.1186/s13018-023-04495-w.

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