Cemented versus uncemented hemiarthroplasty for the management of femoral neck fractures in the elderly: a meta-analysis and systematic review

Li, Lang; Zhao, Xue; Yang, Xiaodong; Yang, Lei; Xing, Fei; Tang, Xueyang

doi:10.1007/s00402-020-03737-4

Cited by 12 publications

(18 citation statements)

References 44 publications

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“…In contrast, cemented stems provide good initial xation regardless of bone morphology, less periprosthetic fractures and postoperative thigh pain, lower cost than cementless stems, and have health economic advantages (12,19,20,22). In this study, the experience rate of periprosthetic fractures was higher than that of cemented stems, and it is important for surgeons to fully recognize the differences between them.…”

Section: Discussionmentioning

confidence: 74%

“…In general, cementless stems do not require additional procedures for cement insertion, resulting in shorter operative times (19). Cementless stems have a large variety of designs and stabilization methods available and require optimal stem design selection to obtain good initial stability (19)(20)(21). Therefore, surgeons need to understand the principles of stem design, such as stem geometry and location of femoral xation (17,18).…”

Section: Discussionmentioning

confidence: 99%

“…However, the experience rate of periprosthetic fracture and subsidence was signi cantly higher in cementless stems in our survey, and the features of cementless stems need to be recognized. In general, cementless stems do not require additional procedures for cement insertion, resulting in shorter operative times (19). Cementless stems have a large variety of designs and stabilization methods available and require optimal stem design selection to obtain good initial stability (19)(20)(21).…”

Section: Discussionmentioning

confidence: 99%

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Current femoral stem fixation in hip arthroplasty for hip fractures after the revised national guidelines in Japan: a questionnaire survey in a super-aging prefectural area

Miura

Kijima

Tazawa

et al. 2022

Preprint

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BackgroundThe Japanese guidelines for the management of hip fractures were most recently revised in 2021 to recommend the use of cemented stems in cases of bone fragility. However, the selection of cementless or cemented stem fixations remains controversial. This study aimed to examine the current stem selection strategy in bipolar hemiarthroplasty, concerns about using cemented stems, and factors affecting the ability to instruct cemented stems.MethodsThis study included 94 orthopedic surgeons from 27 facilities who answered a web-based questionnaire survey of 15 questions in the super-aging prefectural area in Japan from January to February 2022. Multiple logistic regression analysis was used to identify the factors associated with the ability to instruct the cemented stem. The cutoff value for the number of cemented stem usage experiences that can be used to instruct cemented stems was determined using the receiver operating characteristic (ROC) curve.ResultsA total of 97.8% of doctors answered that the cementless stem was the current first choice, and 83.0% of doctors had only 0–10 cases of the cemented stem. Meanwhile, only 14.9% of doctors are expected to increase the use of cemented stems in the future. The cement technique was the greatest concern regarding the use of cement stems (60.6%). On multivariate analysis, the number of surgeries of the cemented stem was the factor most affecting the ability to instruct the cemented stem (odds ratio: 8.42, p=0.001). In the ROC curve analysis for the capability of instructing cemented stems and the number of surgeries using cemented stems, the best cutoff value was 1–10 cases (sensitivity, 94.4%; specificity, 58.6%), with an area under the curve of 0.8448 (95% confidence interval: 0.7754–0.9142). When the cut-off value was 11–50 cases, the specificity was higher (sensitivity, 41.7%; specificity, 98.3%).ConclusionsA few doctors still select cemented stems as the first choice. The number of surgeries on the cemented stem was the factor most affecting the ability to instruct the cemented stem, and more than 11 cases are desirable.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Current femoral stem fixation in hip arthroplasty for hip fractures after the revised national guidelines in Japan: a questionnaire survey in a super-aging prefectural area

Miura

Kijima

Tazawa

et al. 2022

Preprint

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“…In a meta-analysis by Li et al, it was reported that there was no significant difference in mortality after cemented and cementless arthroplasty after hip fracture in elderly patients [ 15 ]. In our study, we have revealed that the mortality rate after cementless partial hip arthroplasty was significantly higher than the groups who underwent osteosynthesis with cemented partial hip arthroplasty, total hip arthroplasty, and proximal femur nail.…”

Section: Discussionmentioning

confidence: 99%

Predictive Value of Blood Parameters and Comorbidities on Three-Month Mortality in Elderly Patients With Hip Fracture

Demirel¹,

Şahin²

2021

Cureus

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BackgroundKnowing the factors that increase the risk of death in patients with hip fractures will help us to take precautions and intervene when necessary in the pre-and postoperative periods. Therefore, it is important to have inexpensive and practical biomarkers that can predict postoperative complications and mortality. The present study aimed to identify the factors that contribute to early mortality in elderly patients with hip fractures in the first three months after trauma, as well as the parameters that may be determinants of mortality. MethodsThe data of 1,015 patients over 65 years of age with femoral neck and intertrochanteric fractures admitted between January 2009 and January 2020 were retrospectively reviewed. A total of 763 patients who met the inclusion criteria were included in the study. Our study was designed to include 110 (14.4%) patients in Group 1 who were determined to have died within three months after the diagnosis of hip fracture and 653 (85.6%) patients in Group 2 who were determined not to have died within one year after the trauma. Age, gender, comorbid diseases, American Society of Anesthesiologists (ASA) score, type of anesthesia, operation time, type of implant used, time until surgery, and some biochemical blood values were compared between the two groups. Our data were analyzed statistically using the IBM Statistical Product and Service Solutions (SPSS) software for Windows, v. 25.0 (IBM SPSS Statistics for Windows, Armonk, NY). ResultsOf all of the patients, 370 (48.5%) were female and 393 (51.5%) were male. The patients who survived had an average age of 76.08, while the patients who died had an average age of 80.57. The mean age among the groups is significantly higher in patients who died. High creatinine, alanine aminotransferase (ALT), lactate dehydrogenase (LDH), and low albumin values were found to be associated with mortality. ConclusionIt has been determined that advanced age, delayed operation time, high ASA score, and the number of comorbid diseases are associated with mortality in elderly patients with hip fractures, and biomarkers, such as creatinine, ALT, and LDH, can be used as markers for early mortality. With the increase of studies of similar nature, it will be possible to calculate a systematic risk map for mortality in elderly patients with a proximal femur fracture.

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“…The initial search string found 393 studies. After screening, 12 studies were included in our sample (Fig 1) [12,13,[24][25][26][27][28][29][30][31][32][33]. The overlapping meta-analyses were published between 2011 to 2021 in different journals, with the number of RCTs in the sample ranging from 5 to 18 (Table 1).…”

Section: Literature Searchmentioning

confidence: 99%

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

et al. 2023

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Background The purpose of our study is to assess the methodology of overlapping systematic reviews related to cemented vs uncemented hip hemiarthroplasties for the treatment of femoral neck fractures to find the study with the best evidence. Also, we assess the gaps in methodology and information to help with direction of future studies. Methods A systematic search was conducted in September 2022 using Pubmed, Embase, and Cochrane Library. Clinical outcome data and characteristics of each study were extracted to see which treatment had better favorability. The outcomes and characteristics extracted from each study includes, first author, search date, publication journal and date, number of studies included, databases, level of evidence, software used, subgroup analyses that were conducted, and heterogeneity with the use of I2 statistics Methodological quality information was extracted from each study using four different methodologic scores (Oxford Levels of Evidence; Assessment of Multiple Systematic Reviews (AMSTAR); Quality of reporting of meta-analyses (QUROM); Oxman and Guyatt. After that, the Jadad decision algorithm was used to identify which studies in our sample contained the best available evidence. Finally, overlap of each systematic review was assessed using Corrected Covered Area (CCA) to look at redundancy and research waste among the systematic reviews published on the topic. Results After screening, 12 studies were included in our sample. For the Oxford Levels of Evidence, we found that all the studies were Level I evidence. For the QUORUM assessment, we had 1 study with the highest score of 18. Additionally, we did the Oxman and Guyatt assessment, where we found 4 studies with a maximum score of 6. Finally, we did an AMSTAR assessment and found 2 studies with a score of 9. After conducting the methodological scores; the authors determined that Li. L et al 2021 had the highest quality. In addition, it was found that the CCA found among the primary studies in each systematic review calculated to .22. Any CCA above .15 is considered “very high overlap”. Conclusions The best available evidence suggests that Cemented HAs are better at preventing Prosthesis-related complications. Conversely, the best evidence also suggests that Cemented HA also results in longer operative time and increased intraoperative blood loss. When conducting future systematic reviews related to the topic, we ask that authors restrict conducting another systematic review until new evidence emerges so as not to confuse the clinical decision-making of physicians.

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Cemented versus uncemented hemiarthroplasty for the management of femoral neck fractures in the elderly: a meta-analysis and systematic review

Cited by 12 publications

References 44 publications

Current femoral stem fixation in hip arthroplasty for hip fractures after the revised national guidelines in Japan: a questionnaire survey in a super-aging prefectural area

Current femoral stem fixation in hip arthroplasty for hip fractures after the revised national guidelines in Japan: a questionnaire survey in a super-aging prefectural area

Predictive Value of Blood Parameters and Comorbidities on Three-Month Mortality in Elderly Patients With Hip Fracture

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

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