What should be the preferred choice of hemiarthroplasty technique in American Society of Anesthesiologists (ASA) class III patients with femoral neck fractures? Cemented or cementless

Çıçek, Hakan; Seyfettinoğlu, Fırat; Kılıçarslan, Kasım; Oğur, Hasan Ulaş; Öztürk, Levent; İnkaya, Erkan

doi:10.1016/j.injury.2015.05.019

Cited by 15 publications

(15 citation statements)

References 18 publications

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“…Finally, 15 articles were found to be eligible and included in the meta-analysis (25-39). Among them, 6 were RCTs (25-30) and 9 were observational studies (31)(32)(33)(34)(35)(36)(37)(38)(39). The PRISMA flow diagram showing the study selection process is shown in Figure 1.…”

Section: Demographics and Characteristicsmentioning

confidence: 99%

A systematic review and meta-analysis of cemented and uncemented bipolar hemiarthroplasty for the treatment of femoral neck fractures in elderly patients over 60 years old

Shen

Ren

et al. 2023

Front. Med.

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BackgroundCurrently, whether bone cement can be applied in bipolar hemiarthroplasty to treat femoral neck fractures (FNFs) in elderly patients is controversial. The aim of this systematic review and meta-analysis was to compare the effectiveness and safety of cemented bipolar hemiarthroplasty (CBH) versus uncemented bipolar hemiarthroplasty (UCBH) in the treatment of FNFs among elderly patients over 60 years old.Materials and methodsThe Pubmed, Web of science, Cochrane Library and EMBASE databases were searched comprehensively for relevant articles from their inception to May 2022. Studies about comparing outcomes between CBH and UCBH for FNFs in elderly patients aged more than 60 years were included. Outcomes including operation time, intra-operative blood loss, length of hospital stay, wound infections, residual pain, revisions, re-operations, complications related to prosthesis, general complications, and mortality. The Review Manager 5.3 software provided by the Cochrane Collaboration Network was used to perform the meta-analysis of comparable data.ResultsA total of 6 randomized controlled trials (RCTs) and 9 observational studies were included in this analysis, with 33,118 patients (33,127 hips). Results of the meta-analysis indicated that the operation time [WMD = 13.01 min, 95% CI (10.79, 15.23)], intra-operative blood loss [WMD = 80.57 ml, 95% CI (61.14, 99.99)], incidence of heterotrophic ossification [OR = 2.07, 95% CI (1,14, 3.78)], were increased in the CBH group but the incidence of intra-operative fractures [OR = 0.24, 95% CI (0.07, 0.86)], periprosthetic fractures [OR = 0.24, 95% CI (0.18, 0.31)], aseptic loosening of prosthesis [OR = 0.20, 95% CI (0.09, 0.44)], wound infections [OR = 0.80, 95% CI (0.68, 0.95)] and re-operation rates [OR = 0.61, 95% CI (0.54, 0.68)] were lower in the CBH group by comparison with the UCHB group. However, there were no significant differences in residual pain, length of hospital stay, prosthetic dislocation, prosthetic subsidence (> 5 mm), acetabulum erosion, revisions, pulmonary infections, pulmonary embolisms, urinary tract infections, deep venous thromboses, decubitus, cardiovascular accidents (arrhythmia/myocardial infarction), and respiratory failure between the two groups. In terms of mortality, perioperative mortality (within 72 h) [OR = 2.39, 95% CI (1.71, 3.32)] and 1-week mortality postoperatively [OR = 1.22, 95% CI (1.05, 1.41)] in CBH group were higher than those in UCBH group, but there were no significant differences in mortality at 1 month, 3 months, 1 year, and 2 years postoperatively between CBH group and UCBH group.ConclusionThis meta-analysis found that elderly patients over 60 years old with FNFs who underwent CBH had longer operation time, higher incidence of heterotrophic ossification, intra-operative blood loss, and mortality within 72 h of operation and at 1-week postoperatively, but lower incidence of periprosthetic fractures, aseptic loosening of prosthesis, intra-operative fractures, wound infections and re-operations. Other outcomes were not significantly different between the two groups.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42021274253

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Section: Demographics and Characteristicsmentioning

confidence: 99%

A systematic review and meta-analysis of cemented and uncemented bipolar hemiarthroplasty for the treatment of femoral neck fractures in elderly patients over 60 years old

Shen

Ren

et al. 2023

Front. Med.

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“…Previously, cemented stems were widely used for femoral neck fractures. However, there is a concern about a cement-related hemodynamic complication, which might be fatal for elderly patients with these fractures1). Because of the possibility of unexpected embolic events during insertion of cemented stems and shorter operation time with cementless implants, a cementless stem could be a reliable treatment option for femoral neck fractures23).…”

Section: Introductionmentioning

confidence: 99%

Favorable Functional Recovery and Stem Stability after Hip Arthroplasty with a Short Metaphyseal Stem in Elderly Patients with Osteoporotic Femoral Neck Fractures

Lee

Yoon

2019

Hip & Pelvis

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PurposeShort stems have recently become widely used; however, concerns about the initial secure fixation of a short stem in osteoporotic bone remain. The aim of this study was to evaluate the short-term clinical and radiological results of using a short cementless metaphyseal stabilizing tapered stem for senile osteoporotic femoral neck fractures.Materials and MethodsThirty-eight arthroplasties (31 bipolar hemiarthroplasties and 7 total hip arthroplasties) were performed for osteoporotic femoral neck fractures in patients older than 65 years (10 males and 28 females). The mean age was 76.1 years and the mean follow-up was 2.9 years. We retrospectively evaluated clinical results, focusing on walking performance, thigh pain, and radiologic results, with special regard to signs of stem stability and osteointegration.ResultsMean Harris hip score was 84.3 points and 68.4% of patients regained their preoperative walking performance. No patients complained about thigh pain. No osteolysis or loosening was observed during the follow-up, and all but 1 stem showed signs of stable bone ingrowth.ConclusionShort, metaphyseal stabilizing tapered stems could be a reliable treatment option for osteoporotic femoral neck fractures.

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“…Of the 34 studies included in our analysis, 12 were randomized clinical trials [ 17 , 20 , 22 , 25 , 42 , 55 , 59 , 60 , 65 , 68 , 69 , 73 ] and 22 were observational studies [ 2 , 7 , 9 , 10 , 24 , 27 , 29 , 30 , 35 , 37 , 40 , 44 , 47 , 51 , 52 , 57 , 61 , 70 , 72 , 75 – 77 ]. The 34 included studies investigated a total of 42,411 participants; among whom 32,385 underwent cemented hemiarthroplasty and 10,026 underwent uncemented hemiarthroplasty (Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…of patients (%) Mean age, years No. female (%) Study period Mean follow-up CH UCH CH UCH CH UCH Prashanth et al 2017 [ 57 ] Observational study 24 (46) 28 (54) 70 30 (58) 2006–2014 59 months Choi et al 2016 [ 9 ] Observational study 115 (64) 65 (36) 77 76 84 (73) 46 (71) 2009–2014 27 months Khorami et al 2016 [ 40 ] Observational study 22 (43) 29 (57) 79 71.1 20 (90) 12 (41) 2011–2013 19.2 months Hong et al 2016 [ 35 ] Observational study 133 (49.1) 138 (50.9) 76 75.2 104 (78.2) 100 (72.5) 2011–2013 12 months Cicek et al 2015 [ 10 ] Observational study 43 (51.2) 41 (48.8) 75.65 77.52 23 (53.5) 23 (56.1) 2007–2012 46.1 months Grammatopoulos et al 2015 [ 30 ] Observational study 292 (71) 120 (29) 82.1 83.4 196 (67.1) 79 (65.8) 2010–2012 12 months Morris et al 2015 [ 51 ] Observational study 33 (41.25) 47 (58.75) 83.3 83.1 12 (36.4) 16 (34) 2013–2014...…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2020

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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.

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What should be the preferred choice of hemiarthroplasty technique in American Society of Anesthesiologists (ASA) class III patients with femoral neck fractures? Cemented or cementless

Cited by 15 publications

References 18 publications

A systematic review and meta-analysis of cemented and uncemented bipolar hemiarthroplasty for the treatment of femoral neck fractures in elderly patients over 60 years old

A systematic review and meta-analysis of cemented and uncemented bipolar hemiarthroplasty for the treatment of femoral neck fractures in elderly patients over 60 years old

Favorable Functional Recovery and Stem Stability after Hip Arthroplasty with a Short Metaphyseal Stem in Elderly Patients with Osteoporotic Femoral Neck Fractures

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

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