Cemented versus Uncemented Hemiarthroplasty for Displaced Femoral Neck Fractures: 5-year Followup of a Randomized Trial

Abstract

Background Displaced femoral neck fractures usually are treated with hemiarthroplasty. However, the degree to which the design of the implant used (cemented or uncemented) affects the outcome is not known and may be therapeutically important. Questions/purposes In this randomized controlled trial, we sought to compare cemented with cementless fixation in bipolar hemiarthroplasties at 5 years in terms of (1) Harris hip scores; (2) femoral fractures; (3) overall health outcomes using the Barthel Index and EQ-5D scores; and (4) complications, reoperations, and mortality since our earlier report on this cohort at 1-year followup. Methods We present followup at a median of 5 years after surgery (range, 56-65 months) from a randomized trial comparing a cemented hemiarthroplasty (112 hips) with an uncemented, hydroxyapatite-coated hemiarthroplasty (108 hips), both with a bipolar head. Results were previously reported at 1-year followup. Harris hip scores, Barthel Index, and EQ-5D scores were assessed by one research nurse and one orthopaedic surgeon. Complications and reoperations were determined by chart review and radiographs examined by three orthopaedic surgeons. Sixty patients (56%) had died in the cemented group and 63 (60%) in the uncemented group. Respectively, three and two patients (2.7% and 1.9%) were completely lost to followup. Results Harris hip scores at 5 years were higher in the uncemented group than in the cemented group (86.2 versus 76.3; mean difference 9.9; 95% confidence interval [CI], 1.9-17.9). The prevalence of postoperative periprosthetic femoral fractures was 7.4% in the uncemented group and 0.9% in the cemented group (hazard ratio [HR], 9.3; 95% CI, 1.16-74.5). Barthel Index and EQ-5D scores were not different between the groups. Between 1 and 5 years, we found no additional infections or dislocations. The mortality rate was not different between the groups (HR, 1.2; 95% CI, 0.82-1.7).

Surgical procedures in femoral neck fractures in Finland: a nationwide study between 1998 and 2011

“…A five year follow-up of a randomised trial with modern stems demonstrated a higher hip score for uncemented HA, but also increased risk of later femoral fractures [29]. Furthermore, two randomised controlled trials conducted by comparing modern uncemented and cemented stems concluded that both methods lead to equivalent functional results [14,21].…”

Effects of a Multicomponent Home-Based Physical Rehabilitation Program on Mobility Recovery After Hip Fracture: A Randomized Controlled Trial

“…There is evidence that uncemented hemiarthroplasty leads to impaired mobility, induces more post-operative pain (Parker, Gurusamy & Azegami 2010, Li et al 2013, mechanical complications of the device (Yli-Kyyny et al 2014, Li et al 2013) and increased reoperation rates (Gjertsen et al 2012, Yli-Kyyny et al 2014 compared to cemented hemiarthroplasty. In contrast, a recent five-year followup study, randomized by surgical method after femoral neck fracture, reported better hip function measured by the Harris Hip Score for uncemented than for cemented hemiarthroplasty (Langslet et al 2013). Another randomized controlled trial for displaced femoral neck fractures reported better quality of life two years after bipolar hemiarthroplasty compared to unipolar hemiarthroplasty, but no differences were found in hip functioning, reoperation rates or mortality (Inngul et al 2013).…”

Cemented hemiarthroplasty in traumatic displaced femoral neck fractures and deep vein thrombosis: is there really a link?

“…Both cemented and uncemented hemiarthroplasty have provided good results. (1)(2)(3)(4)(5) Earlier studies reported a higher risk of DVT in cemented TKR and THR. (6)(7)(8)(9)(10) Several studies have also demonstrated thrombogenic properties of bone cement that may contribute towards the development of DVT.…”

“…Both cemented and uncemented hemiarthroplasty have been used with good results; recent literature shows that both techniques lead to good functional outcomes and postoperative pain control, although some authors reported that uncemented hemiarthroplasty was associated with more implant-related complications. (1)(2)(3)(4)(5) In earlier studies reported in the 1990s, the cemented prosthesis was associated with a higher incidence of deep vein thrombosis (DVT) in total knee replacements (TKR) and total hip replacements (THR). (6)(7)(8)(9)(10) Subsequent studies, however, provided contradictory results and there was a lack of new data thereafter.…”