Cemented versus uncemented hemiarthroplasty for elderly patients with displaced fracture of the femoral neck

Abstract

Background: This meta-analysis was performed to incorporate newly published, high-quality randomized controlled trials (RCTs) to determine the effects of cemented versus uncemented hemiarthroplasty for elderly patients with displaced fracture of the femoral neck. Methods: The following electronic databases were extensively searched from the inception of the database through December 2018: EMBASE, Medline, the Cochrane Library, and Web of Science. RCTs focusing on the outcomes of cemented and uncemented hemiarthroplasty were reviewed and screened for eligibility. We used the Cochrane Collaboration's Review Manager Software to perform meta-analyses. Two independent reviewers extracted the data and assessed the study quality and bias risk through the Cochrane Collaboration tool. Use fixed effect model or random effect model to pooled data. Cochran's Q statistic was used to evaluate heterogeneity, and I 2 statistic was used to quantify heterogeneity. Results: Fifteen RCTs were enrolled (n = 3790) (uncemented hemiarthroplasty group = 1015; cemented hemiarthroplasty group = 1037) (mean age ranged from 70–85.3 years; all patients > 65 years). The meta-analysis showed that cemented hemiarthroplasty has a longer operating time (weighted mean difference, 8.03; 95% confidence interval (CI) 4.83–11.23; P < .00001), less pain (odds ratio, 0.48; 95% CI 4.83–11.23; P = .02), lower mortality 1-year (odds ratio, 0.78; 95% CI 0.62–0.98; P = .03) and fewer implant-related complications (odds ratio, 0.20; 95% CI 0.13–0.30; P < .00001) than Uncemented hemiarthroplasty. However, there are still some limitations in our study, such as the uniformity of the surgery administration programme and rehabilitation scheme, and the small sample size of the included studies. Conclusions: Cemented hemiarthroplasty for elderly patients with displaced fracture of femoral neck may acquire better functional results.

Recommendations from the ICM-VTE: General

“…The incidence of pulmonary embolism (PE) was statistically significantly higher in the cemented group 535 . Conversely, however, Liu et al, found no difference in cardiovascular complications — including PE — in their meta-analysis of 15 RCT encompassing 3,790 patients comparing cemented vs. cementless hemi-arthroplasty for elderly patients with a displaced femoral neck fracture 536 .…”

Comparing Outcomes in Cemented and Press-Fit Hemiarthroplasty

“…6 There exists considerable controversy among orthopaedic surgeons on the proper management of femoral neck fracture in the elderly cohort with respect to cemented or press-fit prostheses. 3,[6][7][8][9][10][11][12][13][14][15][16][17] In our study, there was a statistically significant difference in age for the press-fit versus cemented arthroplasties, with the press-fit patients being an average of 1.4 years younger. We believe this represents a selection bias in which our surgeons were more likely to treat older patients with a cemented arthroplasty.…”

Does the Risk of Death Within 48 Hours of Hip Hemiarthroplasty Differ Between Patients Treated with Cemented and Cementless Implants? A Meta-analysis of Large, National Registries

“…The published small RCTs were designed to assess long-term outcomes and show an almost equal longstanding death rate in hip fracture patients treated with cemented or cementless prostheses [1, 11, 17-19, 23, 25, 31]. Despite the lack of perioperative fatalities as a primary endpoint in the RCTs, systematic reviews have based their short-term surgically related death reports on these trials.…”