Perioperative Complications after Cemented or Uncemented Hemiarthroplasty in Hip Fracture Patients

Abstract

Background and Aims: Both cemented and uncemented hemiarthroplasties are acceptable methods for treating displaced femoral neck fractures. Cemented hemiarthroplasty has traditionally been recommended as being more safe and reliable. However, the cementing process carries a risk of fat embolism and cardiovascular problems. This study attempted to determine whether these complications can be avoided when using a modern uncemented stem. Material and Methods:We retrospectively compared 222 hip fracture patients treated with hemiarthroplasty in our hospital. A total of 100 of these patients were treated with a hydroxyapatite-coated uncemented hemiendoprosthesis (Bi-Metric BFx) and 122 patients with a cemented hemiendoprosthesis (Lubinus SPII). Information on mortality and complications during the first 18.7 months was retrieved from patient files.Results and Conclusions: Nine perioperative fat-embolic events were found in the cemented group and none in the uncemented group. During the initial hospital treatment, there were five deaths (4.1%) in the cemented group and one death (1%) in the uncemented group. There were significantly more perioperative fractures in the uncemented versus cemented group (7% versus 0.8%). We conclude that uncemented hemiarthroplasty is associated with more perioperative fractures than cemented hemiarthroplasty. However, perioperative cardiovascular disturbances may be less frequent with uncemented hemiarthroplasty, and early mortality may be lower with uncemented hemiarthroplasty.

More complications in uncemented compared to cemented hemiarthroplasty for displaced femoral neck fractures: a randomized controlled trial of 201 patients, with one year follow-up

“…Previous papers comparing fracture rate are heterogenic. Some studies found a higher fracture rate in the uncemented group, ranging from 5.5 to 12% [3, 12, 13, 23] whereas others demonstrated no difference in fracture rate [4, 11, 22]. The fracture rate in the current study is higher than previous papers demonstrate.…”

More complications with uncemented than cemented femoral stems in total hip replacement for displaced femoral neck fractures in the elderly

“…Despite this, there have been reports that perioperative cardiovascular disturbances are more frequent in elderly patients with hip fracture when cemented stems are used rather than uncemented (Yli-Kyyny et al. 2013). …”

Treatment of Femoral Neck Fracture with a Minimal Invasive Surgical Approach for Hemiarthroplasty – Clinical and Radiological Results in 180 Geriatric Patients

“…Yli-Kyyny et al had a rate of 4.1% in 122 patients with cemented BHH. Fat embolism was the major cause of death during cementing [35]. Even though we used modern cementing techniques, including cement stopper, retrograde application, pressurisation and cement curing consequently over 14 minutes but this also resulted in collective death.…”