Abstract
Purpose
We wished to compare the outcome of two types of cemented and uncemented modern stem design implants after hemiarthroplasty, with both an Orthopaedic Data Evaluation Panel rating of 10A.
Methods
This retrospective study compares data obtained from two centres, with a total study population of 655 (n = 393 cemented, n = 262 uncemented). Patients were matched at baseline for gender, age, surgery side, American Society of Anesthesiologists score, body mass index and pre-operative haemoglobin level. Outcome measurements were prosthesis-related complications, pre- and post-operative, with reoperation rate and mortality and other complications after 1 year, surgery time, blood loss and immobility at discharge.
Results
There were no significant differences in mortality after 1 year, total other complications, immobility at the time of discharge and total prosthesis-related complications between both groups. Significantly more periprosthetic fractures and post-operative infections were seen in the uncemented group with significantly more reoperations compared to the cemented group. Significant differences were seen in cardiovascular complications, blood loss and surgery time in favour of the uncemented group.
Conclusions
In consequence of the significant higher prosthesis-related complications (e.g. infections, periprosthetic fractures and reoperations) in the uncemented group in this study, we recommend cemented hemiarthroplasty in patients with a femoral neck fracture.
Level of evidence
Level III, Case Controlled Study.
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Notes
ODEP: rates an orthopaedic implant product's compliance with the 10-year benchmarks set by National Institute for Health and Care Excellence (NICE). ODEP listings show all products submitted to ODEP by industry in relation to benchmarks set by NICE. ODEP 10 A rating: A minimum cohort of 500 hips at the start of the study (consisting of data from beyond the developing centre and from more than 3 centres/surgeons) with a minimum of 10-year follow-up and an actual revision rate of less than 5%. All deaths, loss to follow-up, failures and indications for revisions recorded. A maximum of 20% loss to follow-up is permitted.
References
Cheng SY, Levy AR et al (2011) Geographic trends in incidence of hip fractures: a comprehensive literature review. Osteoporos Int 22(10):2575–2586
Holt G, Smith R et al (2008) Early mortality after surgical fixation of hip fractures in the elderly: an analysis of data from the scottish hip fracture audit. J Bone Joint Surg Br 90(10):1357–1363
Foss NB, Kehlet H (2005) Mortality analysis in hip fracture patients: implications for design of future outcome trials. Br J Anaesth 94(1):24–29
Burgers PTPW, Hoogendoorn MV et al (2016) Total medical costs of treating femoral neck fracture patients with hemi- or total hip arthroplasty: a cost analysis of a multicenter prospective study, on behalf of the HEALTH trial investigators. Osteoporos Int 27:1999–2008
Kannan A, Kancherla R et al (2012) Arthroplasty options in femoral-neck fracture: answers from the national registries. Int Orthop 36(1):1–8
Nederlandse Vereniging van Heelkunde & Nederlandse Orthopaedische Vereniging; Richtlijn Proximale femurfracturen (2016) 68–81. https://www.cme-online.nl/sites/www.cme-online.nl/files/2016/08/richtlijn_proximale_femurfracturen.pdf
NICE (2011) The management of hip fracture in adults. https://www.nice.org.uk/guidance/cg124
ODEP Orthopaedic Data Evaluation Panel, U.K. http://www.odep.org.uk/product.aspx?pid=210
Gaski GE, Scully SP (2011) In brief: classifications in brief: Vancouver classification of postoperative periprosthetic femur fractures. Clin Orthop Relat Res 469(5):1507–1510
Li T, Zhuang Q, Weng X et al (2013) Cemented versus uncemented hemiarthroplasty for femoral neck fractures in elderly patients: a meta-analysis. PLoS ONE 8(7):e68903
Luo X, He S, Li Z, Huang D (2012) Systematic review of cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures in older patients. Arch Orthop Trauma Surg 132:455–463
Ning GZ, Li YL, Wu Q et al (2014) Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: an updated meta-analysis. Eur J Orthop Surg Traumatol 24:7–14
Parker MJ, Gurusamy KS, Azegami S (2010) Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. Cochrane Database Syst Rev 16(6):CD001706
Sonne-Holm S, Walter S, Jensen JS (1982) Moore hemi-arthroplasty with and without bone cement in femoral neck fractures. A clinical controlled trial. Acta Orthop Scand 53(6):953–956
Emery RJ, Broughton NS et al (1991) Bipolar hemiarthroplasty for subcapital fracture of the femoral neck. A prospective randomised trial of cemented Thompson and uncemented Moore stems. J Bone Joint Surg Br 73(2):322–324
Figved W, Opland V et al (2009) Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures. Clin Orthop Relat Res 467(9):2426–2435
Parker MI, Pryor G, Gurusamy K (2010) Cemented versus uncemented hemiarthroplasty for intracapsular hip fractures: a randomised controlled trial in 400 patients. J Bone Joint Surg Br 92(1):116–122
Taylor F, Wright M, Zhu M (2012) Hemiarthroplasty of the hip with and without cement: a randomized clinical trial. J Bone Joint Surg Am 94(7):577–583
Deangelis JP, Ademi A, Staff I, Lewis CG (2012) Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: a prospective randomized trial with early follow-up. J Orthop Trauma 26(3):135–140
Branfoot T, Faraj AA, Porter P (2000) Cemented versus uncemented Thompson’s prosthesis: a randomised prospective functional outcome study. Injury 31:280–281
Harper WM, Greg PJ (1992) The treatment of intracapsular proximal femoral fractures: a randomized prospective trial. J Bone Joint Surg 74(Suppl iii):282
Santini S, Rebeccato A et al (2005) Hip fractures in elderly patients treated with bipolar hemiarthroplasty: comparison between cemented and cementless implants. J Orthopaed Traumatol 6:80–87
Dorr LD, Glousman R et al (1986) Treatment of femoral neck fractures with total hip replacement versus cemented and noncemented hemiarthroplasty. J Arthroplast 1(1):21–28
Moroni A, Pegreffi F et al (2009) Result in osteoporotic femoral neck fractures treated with cemented versus uncemented hip arthroplasty. J Bone Joint Surg Br 91-B(SUPP I):167
Cumming D, Parker M (2012) Randomised trial of cemented versus uncemented hemiarthroplasty for displaced intracapsular fractures. J Bone Joint Surg Br 94-B(SUPP III):63
Veldman HD, Heyligers IC et al (2017) Cemented versus cementless hemiarthroplasty for a displaced fracture of the femoral neck: a systematic review and meta-analysis of current generation hip stems. Bone Joint J 99-B(4):421–431
Langslet E, Frihagen F et al (2014) Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: 5-year followup of a randomized trial. Clin Orthop Relat Res 472:1291–1299
Talsnes O, Hjelmstedt F et al (2013) No difference in mortality between cemented and uncemented hemiprosthesis for elderly patients with cervical hip fracture. A prospective randomized study on 334 patients over 75 years. Arch Orthop Trauma Surg 133:805–809
Goltzman D (2002) Discoveries, drugs and skeletal disorders. Nat Rev Drug Discov 1:784–796
Hordon LD, Peacock M (1990) Osteomalacia and osteoporosis in femoral neck fracture. Bone Miner 11:247–259
Wang J, Zhu C et al (2013) A systematic review and meta-analysis of antibiotic-impregnated bone cement use in primary total hip or knee arthroplasty. PLoS One. 12(8):e82745
Pitto RP, Koessler M, Kuehle JW (1999) Comparison of fixation of the femoral component without cement and fixation with use of a bone-vacuum cementing technique for the prevention of fat embolism during total hip arthroplasty. A prospective, randomized clinical trial. J Bone Joint Surg Am 81(6):831–843
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MRM Frenken, MGM Schotanus, EH van Haaren and R Hendrickx declare that they have no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangements) that might pose a conflict of interest in connection with the submitted manuscript.
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Frenken, M.R.M., Schotanus, M.G.M., van Haaren, E.H. et al. Cemented versus uncemented hemiarthroplasty of the hip in patients with a femoral neck fracture: a comparison of two modern stem design implants. Eur J Orthop Surg Traumatol 28, 1305–1312 (2018). https://doi.org/10.1007/s00590-018-2202-2
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DOI: https://doi.org/10.1007/s00590-018-2202-2