Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: 5-year followup of a randomized trial.
Orthopaedic Department, Baerum Hospital, Vestre Viken Hospital Trust, 1309, Rud, Norway
Clinical Orthopaedics and Related Research,April 2014, Volume 472, Issue 4, pp 1291-1299
Level 1 Randomized Control Trial
BACKGROUND: Displaced fractures of the femoral neck in the elderly are usually treated with hemiarthroplasty. It has long been debated whether cemented or cementless stems are superior in this scenario
Fundamental Research QUESTION: How do femoral stems of cemented and uncemented hemiarthroplasty perform when assessed for function at 5 years postoperative period?
Population: 223 patients (230 intracapsular hip fractures) above 70 years who underwent bipolar hemiarthroplasty for fracture neck of femur
Intervention: Uncemented Bipolar Hemiarthroplasty-115 hips (Corail stem, DePuy Johnson and Johnson) with a mobilecup, Mean age: 83 years, 62% died at 5 years follow up
Comparison: Cemented Bipolar Hemiarthroplasty-115 hips (Spectron, Smith and Nephew), Mean age: 83.4 years, 61% died at 5 years follow up Follow up: 5 years after surgery (range, 56-65 months) Methods: Randomized trial
Outcome measures: Primary: Harris hip score. Secondary: Barthel Index, and EQ-5D . Also assessment of complications, reoperations and mortality
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). No difference in EQ 5D or Barthel Index between 2 groups. Postoperative periprosthetic femoral fracture prevalence: 7.4% in the uncemented group and 0.9% in the cemented group (hazard ratio [HR], 9.3; 95% CI, 1.16-74.5). The mortality rate was not different between the groups (HR, 1.2; 95% CI, 0.82-1.7).
CONCLUSIONS: Both cemented and uncemented hemiarthroplasty performed very well in mid term results. Although there was higher Harris Hip Scores in the uncemented group, it was associated with higher rate of periprosthetic fractures.
LEVEL OF EVIDENCE: Level I, therapeutic study.