The Effect of Type of Femoral Component Fixation on Mortality and Morbidity after Hip Hemiarthroplasty: A Systematic Review and Meta-Analysis

Abstract

Background Hip hemiarthroplasty is a well-established treatment of displaced femoral neck fracture, although debate exists over whether cemented or uncemented fixation is superior. Uncemented prostheses have typically been used in younger, healthier patients and cemented prostheses in older patients with less-stable bone. Also, earlier research has suggested that bone cement has cytotoxic effects and may trigger cardiovascular and respiratory adverse events. Questions/Purposes The aim of this systematic review and meta-analysis was to compare morbidity and mortality rates after cemented and uncemented hemiarthroplasty for the treatment of displaced femoral neck fractures in elderly patients. Methods Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched seven medical databases for randomized clinical trials and observational studies. We compared cemented and uncemented hemiarthroplasty using the Harris Hip Score (HHS), as well as measures of postoperative pain, mortality, and complications. Data were extracted and pooled as risk ratios or standardized mean difference with their corresponding 95% confidence intervals in a meta-analysis model. Results The meta-analysis included 34 studies (12 randomized trials and 22 observational studies), with a total of 42,411 patients. In the pooled estimate, cemented hemiarthroplasty was associated with less risk of postoperative pain than uncemented hemiarthroplasty. There were no significant differences between groups regarding HHS or rates of postoperative mortality, pulmonary embolism, cardiac arrest, myocardial infarction, acute cardiac arrhythmia, or deep venous thrombosis. Conclusions While we found that cemented hemiarthroplasty results in less postoperative pain than uncemented hemiarthroplasty in older patients with femoral neck fracture, the lack of significant differences in functional hip scores, mortality, and complications was surprising. Further high-level research is needed.

Which factor is more associated with survival of patients with hip fracture over 90 years: Type of fracture or treatment modality?

“…Cemented femoral component fixation is used in patients with poor bone quality, lower revision rates and thigh pain, but it may be associated with cardiorespiratory collapse, embolism and higher perioperative and early postoperative mortality [ 22 , 23 ]. However, systematic reviews and meta-analysis including extremely large patient groups reported that there was no significant difference between cemented or uncemented HA regarding postoperative mortality rates [ 24 , 25 ]. Nevertheless, our study had several strengths.…”

Outcomes of Femoral Neck Fractures in Young Patients and the Factors Associated With Complications: A Multicenter Study From Malaysia

“…The main disadvantage of a primary femoral head replacement surgery is the finite years of implant survival and risk of dislocation, making primary femoral head replacement surgery a subject of controversy as a treatment method in young patients with femoral neck fracture [25][26][27]. In spite of this, the advancement in implant design, superior highly cross-link polyethylene liners, and improved surgical techniques have contributed to longer survival rates in THR [25].…”

Mortality, Morbidity and Quality of Life of Patients Operated on By Intermediate Hip Prosthesis for Femoral Neck Fracture in Cotonou

“…The vital prognosis after a femoral neck fracture is poor, with a one-year mortality rate of between 16% and 29% in numerous studies [4]. It is also associated with a high morbidity rate, and disability that significantly affects quality of life [1,5,6]. Indeed, many authors have shown that femoral neck fractures have a negative impact on quality of life and activities of daily living in men and women of all ages [10,11].…”