Cemented versus uncemented arthroplasty for the management of femoral neck fractures in the elderly

Abstract

Background Hemiarthroplasty and total hip arthroplasty (TKA) are commonly used to treat unstable femoral neck fractures in older patients. However, there is no consensus on the use of cement during hemiarthroplasty and TKA. Previous reviews on this subject included small number of studies and lacked evidence grading of outcomes. In this study, we aimed to compare the outcomes of cemented and uncemented arthroplasty for the treatment of femoral neck fractures in older patients. Methods A meta-analysis was conducted according to the guidelines of the Cochrane Collaboration using online databases (Pubmed, Cochrane Central Register of Controlled Trials, and Ovid). The quality of the included studies was assessed using the Cochrane Collaboration tool and Newcastle-Ottawa Scale. Prospective cohort studies and randomized controlled trials (RCT) of cemented arthroplasty versus uncemented arthroplasty for treatment of femoral neck fractures were analyzed using Review Manager (version 5.2) software. Results Sixteen studies were included in the meta-analysis. Cemented arthroplasty was found to be superior to uncemented arthroplasty with respect to reoperation rate, complications related to prosthesis, residual pain, and operation time. There were no significant between-group differences with respect to local and general complications, duration of hospital stay, hip function, and mortality. Conclusion Compared with cemented arthroplasty, uncemented arthroplasty was associated with a greater risk of complications related to prosthesis, reoperation rate, residual pain, and longer operation time. However, the results of this meta-analysis should be interpreted cautiously owing to some limitations. Further studies are required to provide more robust evidence.