Meta-Analysis of a Complex Network of Non-Pharmacological Interventions: The Example of Femoral Neck FractureReportar como inadecuado

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Surgical interventions raise specific methodological issues in network meta-analysis NMA. They are usually multi-component interventions resulting in complex networks of randomized controlled trials RCTs, with multiple groups and sparse connections.


To illustrate the applicability of the NMA in a complex network of surgical interventions and to prioritize the available interventions according to a clinically relevant outcome.


We considered RCTs of treatments for femoral neck fracture in adults. We searched CENTRAL, MEDLINE, EMBASE and up to November 2015. Two reviewers independently selected trials, extracted data and used the Cochrane Collaboration’s tool for assessing the risk of bias. A group of orthopedic surgeons grouped similar but not identical interventions under the same node. We synthesized the network using a Bayesian network meta-analysis model. We derived posterior odds ratios ORs and 95% credible intervals 95% CrIs for all possible pairwise comparisons. The primary outcome was all-cause revision surgery.


Data from 27 trials were combined, for 4,186 participants 72% women, mean age 80 years, 95% displaced fractures. The median follow-up was 2 years. With hemiarthroplasty HA and total hip arthroplasty THA as a comparison, risk of surgical revision was significantly higher with the treatments unthreaded cervical osteosynthesis OR 8.0 95% CrI 3.6–15.5 and 5.9 2.4–12.0, respectively, screw 9.4 6.0–16.5 and 6.7 3.9–13.6 and plate 12.5 5.8–23.8 and 7.8 3.8–19.4.


In older women with displaced femoral neck fractures, arthroplasty HA and THA is the most effective treatment in terms of risk of revision surgery.

Systematic Review Registration

PROSPERO no. CRD42013004218.

Level of Evidence

Network Meta-Analysis, Level 1.

Autor: Jonathan Mosseri , Ludovic Trinquart , Rémy Nizard, Philippe Ravaud



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