Operative Management of Displaced Femoral Neck Fractures in Elderly Patients

Bhandari, Mohit; Devereaux, P. J.; Tornetta, Paul; Swiontkowski, Marc F.; Berry, Daniel J.; Haidukewych, George; Schemitsch, Emil H.; Hanson, Beate; Koval, Kenneth J.; Dirschl, Douglas R.; Leece, Pamela; Keel, Marius; Petrisor, Brad; Heetveld, Martin J.; Guyatt, Gordon

doi:10.2106/jbjs.e.00535

Cited by 404 publications

(348 citation statements)

References 7 publications

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“…uncemented hemiarthroplasties using a proximal press-fit design showed excellent results [2], but other results of uncemented hemiarthroplasties, often using stems different from those in THA, are more uncertain. The uncemented Austin Moore prosthesis (Howmedica, Rutherford, NJ) is commonly used [3], and several randomized trials included in review articles include the results of this specific implant. One randomized trial reported better results regarding pain when using an uncemented HA-coated implant in comparison to results with the Austin Moore prosthesis [25].…”

Section: Discussionmentioning

confidence: 99%

“…Thirty-six surgeons performed a median of five operations each (range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Patients underwent a bipolar The cemented stem is a straight, collared stem made of a cobalt-chromium alloy.…”

Section: Methodsmentioning

confidence: 99%

“…Hemiarthroplasty is the most common treatment for displaced fractures of the femoral neck in the elderly [3] and is associated with better functional outcome and fewer reoperations than internal fixation [12,30]. A large number of prostheses have been used, and no definite conclusions have been made regarding which type of arthroplasty is preferred [29].…”

Section: Introductionmentioning

confidence: 99%

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Cemented versus Uncemented Hemiarthroplasty for Displaced Femoral Neck Fractures

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Opland

Frihagen

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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Hemiarthroplasty is the most commonly used treatment for displaced femoral neck fractures in the elderly. There is limited evidence in the literature of improved functional outcome with cemented implants, although serious cement-related complications have been reported. We performed a randomized, controlled trial in patients 70 years and older comparing a cemented implant (112 hips) with an uncemented, hydroxyapatite-coated implant (108 hips), both with a bipolar head. The mean Harris hip score showed equivalence between the groups, with 70.9 in the cemented group and 72.1 in the uncemented group after 3 months (mean difference, 1.2) and 78.9 and 79.8 after 12 months (mean difference, 0.9). In the uncemented group, the mean duration of surgery was 12.4 minutes shorter and the mean intraoperative blood loss was 89 mL less. The Barthel Index and EQ-5D scores did not show any differences between the groups. The rates of complications and mortality were similar between groups. Both arthroplasties may be used with good results after displaced femoral neck fractures.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cemented versus Uncemented Hemiarthroplasty for Displaced Femoral Neck Fractures

Figved

Opland

Frihagen

et al. 2009

Clinical Orthopaedics &Amp; Related Research

212

193

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“…Thirty-six surgeons performed a median of five operations each (range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Patients underwent a bipolar hemiarthroplasty with either a cemented femoral stem (Spectron; Smith & Nephew, Memphis, TN, USA) (Fig.…”

Section: Methodsmentioning

confidence: 99%

“…Many types of arthroplasties are used to treat displaced fractures of the femoral neck in the elderly [1]. There is some evidence of inferior short-term results with decreased mobility and pain when using an uncemented implant, but the diversity of implants used in clinical trials represents a problem [19].…”

Section: Introductionmentioning

confidence: 99%

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

Langslet

Frihagen

Opland

et al. 2014

Clinical Orthopaedics &Amp; Related Research

187

162

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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).

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