Cemented versus Uncemented Hemiarthroplasty for Displaced Femoral Neck Fractures

Abstract

Hemiarthroplasty is the most commonly used treatment for displaced femoral neck fractures in the elderly. There is limited evidence in the literature of improved functional outcome with cemented implants, although serious cement-related complications have been reported. We performed a randomized, controlled trial in patients 70 years and older comparing a cemented implant (112 hips) with an uncemented, hydroxyapatite-coated implant (108 hips), both with a bipolar head. The mean Harris hip score showed equivalence between the groups, with 70.9 in the cemented group and 72.1 in the uncemented group after 3 months (mean difference, 1.2) and 78.9 and 79.8 after 12 months (mean difference, 0.9). In the uncemented group, the mean duration of surgery was 12.4 minutes shorter and the mean intraoperative blood loss was 89 mL less. The Barthel Index and EQ-5D scores did not show any differences between the groups. The rates of complications and mortality were similar between groups. Both arthroplasties may be used with good results after displaced femoral neck fractures.

Cemented versus Uncemented Hemiarthroplasty for Displaced Femoral Neck Fractures: 5-year Followup of a Randomized Trial

“…When we evaluated results of this trial at 1 year, we found comparable outcomes between the two groups for all outcome measures studied [5], and, specifically, the mean Harris hip score was equivalent between the groups at 3 months and 1 year; the duration of surgery and intraoperative blood loss were less in the uncemented group (Table 1). Because few studies have followed randomized hip fracture cohorts up to 5 years, there are limited data on late complications and implant longevity.…”

“…This prospective, randomized equivalence trial was performed at two hospitals; results previously were reported at 1 year [5]. One hundred fifty fractures were included at a district hospital and 80 fractures were included at a university hospital from September 2004 to August 2006.…”

“…They were followed at 3 and 12 months and now after 5 years. As previously described [5], patients aged 70 years or older who were admitted to one of the two participating hospitals with a displaced intracapsular femoral neck fracture were eligible for inclusion. Exclusion criteria were being unfit for arthroplasty according to the anesthesiologist on call, previous symptomatic hip pathology such as osteoarthritis, fracture caused by malignant disease, patients with ongoing infectious disease, and patients who were unable to walk before the fracture.…”

“…Thirty-six surgeons performed a median of five operations each (range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Patients underwent a bipolar hemiarthroplasty with either a cemented femoral stem (Spectron; Smith & Nephew, Memphis, TN, USA) (Fig.…”

“…We therefore called in patients from our earlier randomized trial [5] at a median followup of 5 years to compare cemented with cementless fixation in bipolar hemiarthroplasties in terms of (1) Harris hip scores; (2) femoral fractures; (3) overall health outcomes using the Barthel Index and EQ-5D score; and (4) complications, reoperations, and mortality since our earlier report on this cohort at 1-year followup [5].…”