Historically, did Cemented Thompson perform better than uncemented Austin Moore hemiarthroplasty for femoral neck fractures? A meta-analysis of available evidence

Abstract

Introduction: Thompson and Austin Moore prostheses have been commonly used in hemiarthroplasties for displaced femoral neck fractures. There has been considerable debate about which of these prostheses is preferred. The purpose of this meta-analysis was to compare historical data for clinical outcomes of cemented Thompson and uncemented Austin Moore hemiarthroplasty in displaced femoral neck fractures. Methods: We searched Medline via PubMed, Cochrane Central, Scopus, Ovid and Web of Science for relevant articles up to February 2019. The included outcomes measured were hip function, hip pain, implant-related complications, surgical complications, reoperation rate and hospital stay. The data were pooled as risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI) between the two compared groups in a meta-analysis model. Results: Ten studies (four RCTs and six observational studies) with a total of 4378 patients were included in the final analysis. The pooled RR showed that the Thompson group was associated with a lower incidence of postoperative hip pain (RR = 0.66, 95% CI [0.54, 0.80]), lesser reoperation rate (RR = 0.46, 95% CI [0.24, 0.88]), lesser intraoperative fractures (RR = 0.15, 95% CI [0.09, 0.25]), but a longer operative time (MD = 12.04 min, 95% CI [2.08, 22.00]) in comparison to the Austin Moore group. The effect estimate did not favour either group in terms of hip function, periprosthetic fractures, prosthetic dislocations, wound infection, mortality and hospital stay. Conclusion: Evidence shows that Thompson hemiarthroplasty is better than Austin Moore hemiarthroplasty in terms of hip pain, reoperation rate and intraoperative fractures. Whereas the postoperative hip function is equivalent, these results could be considered when assessing the outcomes in modern hips.

Effectiveness and safety of cemented and uncemented hemiarthroplasty in the treatment of intracapsular hip fractures

“…6,10 In a 2019 review based on 4 RCTs and 6 observational studies, lower pooled reoperation and revision rates for cemented HA were reported. 11 In our study, based on more RCTs, we showed no significant differences. New findings include no significant differences in vascular complications (e.g.…”

“…Unlike previous reviews, we have compared outcomes separately for contemporary and non-contemporary implants and reported new findings. The majority of previous reviews in this area evaluated mortality at oneyear or at undefined time points, 7,8,10,11 whereas our review evaluated multiple time points (peri-operative, 30day, 1 year). The finding of longer operative time associated with cemented HA is consistent with previous reviews, [6][7][8]10,12 as are no significant differences in complications such as infection and dislocation.…”

“…Previous reviews have shown cemented HA to be associated with longer operation times and fewer implantrelated complications. [6][7][8][9][10] Some reviews have shown equivalent pain outcomes, 8 blood loss, 6,8 and risk of general complications [6][7][8] but others have shown less residual pain 6,7,11 but greater blood loss with cemented HA 12 and more complications with uncemented HA. 9 Previous reviews are limited by, first, inclusion of old studies of non-contemporary prostheses.…”