Cemented Versus Uncemented Hemiarthroplasty for Displaced Femoral Neck Fractures: A Randomized Controlled Trial with Two Years Follow-up

Overview

Journal Acta Orthop Traumatol Turc

Specialties Emergency Medicine
Orthopedics

Date 2020 Mar 17

PMID 32175901

Citations 9

Authors

Igor Movrin

Affiliations

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Abstract

Objective: The aim of this prospective randomized trial was to compare cemented (CHA) and uncemented bipolar hemiarthroplasty (UCH) in patients with femoral neck fractures (FNF).

Methods: The study included 158 patients aged ≥76 years who underwent bipolar HA for displaced FNF. Patients were randomized in two groups: the cemented group (CHA, n=79) was treated with cement and the uncemented group (UCH, n=79) without cement. The groups were compared for operating time, blood loss and peroperative morbidity and mortality rates.

Results: Both the CHA and the UCH group did not differ significantly in terms of age (86±5 vs. 84±4 years), sex (58.3% male vs. 60.7% female), and comorbidities (p=0.49). The CHA group had a significantly longer operating time (p=0.038) and a greater intraoperative blood loss (p=0.024). In the CHA group there were 8 (10.1%) events of intraoperative drop in the oxygen saturation (SaO2), whereas no such events were noted in the UCH group (p=0.009). Despite no significant difference between these two groups, we found that the CHA group was associated with a higher early postoperative mortality (8.8% in the CHA group versus 3.8% in the UCH group, p=0.009). Intraoperative fracture occurred in two patients (2.5%) of the UCH group. Over a 2-year follow-up period there were no significant differences between the groups regarding the rate of dislocation (p=0.56) or rate of postoperative periprosthetic fracture (p=0.56). There was a trend towards a better postoperative functional recovery at 6 week for the CHA group (77.1±13.1 versus 71.3±16.3), although the mean Harris Hip Score (HHS) at the end of 2 years was comparable (p=0.55).

Conclusion: Both CHA and UCH are acceptable methods for treating displaced femoral neck fractures. However, based on our results perioperative cardiovascular disturbances are less frequent and resulting in a potential lower early mortality with UCH. Therefore, UCH is particularly appropriate for elderly patients with pre-existing cardiovascular comorbidities.

Level Of Evidence: Level II, Randomized Controlled Trial.

Citing Articles

Samaheen M, Mohammad M, Salzmann M, Ramadanov N Orthop Surg. 2024; 17(2):361-372.

PMID: 39726286 PMC: 11787973. DOI: 10.1111/os.14339.

A meta-analysis comparing the effects of cemented and uncemented prostheses on wound infection and pain in patients with femoral neck fractures.

Xu Z, Zhang K, Cheng K, Sun G, Zhang Y, Jia J Int Wound J. 2023; 20(10):4122-4129.

PMID: 37555547 PMC: 10681411. DOI: 10.1111/iwj.14306.

The Comparison between Cemented and Uncemented Hemiarthroplasty in Patients with Femoral Neck Fractures: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

He Y, Tang X, Liao Y, Liu S, Li L, Li P Orthop Surg. 2023; 15(7):1719-1729.

PMID: 37154088 PMC: 10350391. DOI: 10.1111/os.13716.

Cemented vs Uncemented hemiarthroplasties for femoral neck fractures: An overlapping systematic review and evidence appraisal.

Reddy A, Scott J, Norris G, Moore C, Checketts J, Hughes G PLoS One. 2023; 18(2):e0281090.

PMID: 36827316 PMC: 9955942. DOI: 10.1371/journal.pone.0281090.

A systematic review and meta-analysis of cemented and uncemented bipolar hemiarthroplasty for the treatment of femoral neck fractures in elderly patients over 60 years old.

Fu M, Shen J, Ren Z, Lv Y, Wang J, Jiang W Front Med (Lausanne). 2023; 10:1085485.

PMID: 36817792 PMC: 9932906. DOI: 10.3389/fmed.2023.1085485.

References

DeAngelis J, Ademi A, Staff I, Lewis C . Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: a prospective randomized trial with early follow-up. J Orthop Trauma. 2011; 26(3):135-40. DOI: 10.1097/BOT.0b013e318238b7a5. View

Hynes M, Calder P, Rosenfeld P, Scott G . The use of tranexamic acid to reduce blood loss during total hip arthroplasty: an observational study. Ann R Coll Surg Engl. 2005; 87(2):99-101. PMC: 1963881. DOI: 10.1308/147870805X28118. View

Luo X, He S, Li Z, Huang D . Systematic review of cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures in older patients. Arch Orthop Trauma Surg. 2011; 132(4):455-63. DOI: 10.1007/s00402-011-1436-9. View

Duckworth A, Phillips S, Stone O, Moran M, Breusch S, Biant L . Deep infection after hip fracture surgery: predictors of early mortality. Injury. 2012; 43(7):1182-6. DOI: 10.1016/j.injury.2012.03.029. View

Azegami S, Gurusamy K, Parker M . Cemented versus uncemented hemiarthroplasty for hip fractures: a systematic review of randomised controlled trials. Hip Int. 2011; 21(5):509-17. DOI: 10.5301/HIP.2011.8640. View

Benoni G, Fredin H, Knebel R, Nilsson P . Blood conservation with tranexamic acid in total hip arthroplasty: a randomized, double-blind study in 40 primary operations. Acta Orthop Scand. 2001; 72(5):442-8. DOI: 10.1080/000164701753532754 . View

Figved W, Opland V, Frihagen F, Jervidalo T, Madsen J, Nordsletten L . Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures. Clin Orthop Relat Res. 2009; 467(9):2426-35. PMC: 2866935. DOI: 10.1007/s11999-008-0672-y. View

Costa M, Griffin X, Pendleton N, Pearson M, Parsons N . Does cementing the femoral component increase the risk of peri-operative mortality for patients having replacement surgery for a fracture of the neck of femur? Data from the National Hip Fracture Database. J Bone Joint Surg Br. 2011; 93(10):1405-10. DOI: 10.1302/0301-620X.93B10.26690. View

Ekback G, Axelsson K, Ryttberg L, Edlund B, Kjellberg J, Weckstrom J . Tranexamic acid reduces blood loss in total hip replacement surgery. Anesth Analg. 2000; 91(5):1124-30. DOI: 10.1097/00000539-200011000-00014. View

10.

Foss N, Kehlet H . Mortality analysis in hip fracture patients: implications for design of future outcome trials. Br J Anaesth. 2004; 94(1):24-9. DOI: 10.1093/bja/aei010. View

11.

Soderman P, Malchau H . Is the Harris hip score system useful to study the outcome of total hip replacement?. Clin Orthop Relat Res. 2001; (384):189-97. DOI: 10.1097/00003086-200103000-00022. View

12.

Middleton R, Uzoigwe C, Young P, Smith R, Gosal H, Holt G . Peri-operative mortality after hemiarthroplasty for fracture of the hip: does cement make a difference?. Bone Joint J. 2014; 96-B(9):1185-91. DOI: 10.1302/0301-620X.96B9.33935. View

13.

Costain D, Whitehouse S, Pratt N, Graves S, Ryan P, Crawford R . Perioperative mortality after hemiarthroplasty related to fixation method. Acta Orthop. 2011; 82(3):275-81. PMC: 3235304. DOI: 10.3109/17453674.2011.584208. View

14.

Griffiths R, White S, Moppett I, Parker M, Chesser T, Costa M . Safety guideline: reducing the risk from cemented hemiarthroplasty for hip fracture 2015: Association of Anaesthetists of Great Britain and Ireland British Orthopaedic Association British Geriatric Society. Anaesthesia. 2015; 70(5):623-6. PMC: 6681143. DOI: 10.1111/anae.13036. View

15.

Talsnes O, Vinje T, Gjertsen J, Dahl O, Engesaeter L, Baste V . Perioperative mortality in hip fracture patients treated with cemented and uncemented hemiprosthesis: a register study of 11,210 patients. Int Orthop. 2013; 37(6):1135-40. PMC: 3664168. DOI: 10.1007/s00264-013-1851-3. View

16.

Pitto R, Koessler M, Kuehle J . Comparison of fixation of the femoral component without cement and fixation with use of a bone-vacuum cementing technique for the prevention of fat embolism during total hip arthroplasty. A prospective, randomized clinical trial. J Bone Joint Surg Am. 1999; 81(6):831-43. DOI: 10.2106/00004623-199906000-00010. View

17.

Brown T, Larson B, Shen F, Moskal J . Thigh pain after cementless total hip arthroplasty: evaluation and management. J Am Acad Orthop Surg. 2002; 10(6):385-92. DOI: 10.5435/00124635-200211000-00002. View

18.

de Jong L, Klem T, Kuijper T, Roukema G . Factors affecting the rate of surgical site infection in patients after hemiarthroplasty of the hip following a fracture of the neck of the femur. Bone Joint J. 2017; 99-B(8):1088-1094. DOI: 10.1302/0301-620X.99B8.BJJ-2016-1119.R1. View

19.

Khan R, MacDowell A, Crossman P, Keene G . Cemented or uncemented hemiarthroplasty for displaced intracapsular fractures of the hip--a systematic review. Injury. 2002; 33(1):13-7. DOI: 10.1016/s0020-1383(01)00101-2. View

20.

Jo W, Lee Y, Ha Y, Park M, Lyu S, Koo K . Frequency, Developing Time, Intensity, Duration, and Functional Score of Thigh Pain After Cementless Total Hip Arthroplasty. J Arthroplasty. 2016; 31(6):1279-1282. DOI: 10.1016/j.arth.2015.12.016. View