Cemented calcar replacement versus cementless hemiarthroplasty for unstable intertrochanteric femur fractures in elderly.

Abstract

BACKGROUND: Unstable intertrochanteric fractures remain a challenging problem in elderly individuals due to high failure rates associated with internal fixation. Hemiarthroplasty is one treatment option for intertrochanteric femur fractures in elderly patients. The aim of the present study was to compare the reliability of cementless and cemented hemiarthroplasty for unstable intertrochanteric femur fractures in elderly patients.

Comparison between Cementless and Cemented Bipolar Hemiarthroplasty for Treatment of Unstable Intertrochanteric Fractures: Systematic Review and Meta-analysis

“…Despite this, many orthopedic surgeons remain concerned about increased mortality from fat embolization due to increased intramedullary pressure during cementation 14 54 55 59 60 61) . Moreover, according to a comparative study by Cankaya et al 13) on cemented and cementless stems in unstable intertrochanteric fractures, cement was reported to be the factor that increased mortality. There are, however, a number of other studies which report that the use of cement does not increase mortality 14 59 60) .…”

“…However, in cases of unstable intertrochanteric fractures, it is difficult to achieve stable fixation and identify the anatomic structure because of comminution and displacement of the bones near the stem; this injury is also associated with risks of complications (e.g., greater trochanteric nonunion, heterotopic ossification [HO]). Additionally, cement-related fatal cardiovascular complications are also present 11 12 13) . Therefore, the decisions on which surgical approach and prosthesis to use become very important, particularly which type of stem, just as is the case with femoral neck 14) .…”

Comparison of femur intertrochanteric fracture fixation with hemiarthroplasty and proximal femoral nail systems

“…Studies have concluded that cementless hemiarthroplasty is preferred over cemented hemiarthroplasty because of reduced operation time and intra-operative blood loss and lower perioperative mortality rate. [15,16] For the ideal internal fixation method, a meta-analysis performed by Zhang et al hasconcluded that PFN may be a better choice than DHS in the treatment of intertrochanteric fractures. [17] In a study of one hundred consecutive patients treated with PFN, Korkmaz et al have concluded that PFN is a reliable fixation method for proximal femur fractures.…”

Cementless calcar-replacement stem with integrated greater trochanter plate for unstable intertrochanteric fracture in very elderly patients

“…Moreover, the use of cementless implants might have reduced the mortality rate. Cankaya et al 21 reported that for unstable intertrochanteric fractures in elderly patients, the perioperative mortality rate was significantly lower in the cementless hemiarthroplasty group than in the cemented hemiarthroplasty group. They also stated that cementation affects mortality by elevating the intramedullary pressure, which leads to fat embolization.…”