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

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

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).

Conclusions

Both arthroplasties may be used with good medium-term results after displaced femoral neck fractures. The uncemented hemiarthroplasty may result in higher hip scores but appears to carry an unacceptably high risk of later femoral fractures.

Level of Evidence

Level I, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank research nurse Merete Finjarn for impeccable data collection and patient logistics; and Asbjørn Hjall and Wenche Sørensen for initiation support and making this trial feasible in a busy orthopaedic department. We also thank Are Hugo Pripp PhD, Senior scientist, Department of Biostatistics, Epidemiology and Health Economics, Oslo University Hospital, for expert statistical advice.

Author information

Authors and Affiliations

  1. Orthopaedic Department, Baerum Hospital, Vestre Viken Hospital Trust, 1309, Rud, Norway

    Ellen Langslet MD, Vidar Opland MD & Wender Figved MD, PhD

  2. Department of Orthopaedics, Oslo University Hospital, Oslo, Norway

    Ellen Langslet MD, Frede Frihagen MD, PhD, Jan Erik Madsen MD, PhD & Lars Nordsletten MD, PhD

  3. Faculty of Medicine, University of Oslo, Blindern, Oslo, Norway

    Jan Erik Madsen MD, PhD, Lars Nordsletten MD, PhD & Wender Figved MD, PhD

Authors
  1. Ellen Langslet MD
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  2. Frede Frihagen MD, PhD
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  3. Vidar Opland MD
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  4. Jan Erik Madsen MD, PhD
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  5. Lars Nordsletten MD, PhD
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  6. Wender Figved MD, PhD
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Corresponding author

Correspondence to Wender Figved MD, PhD.

Additional information

The institution of the authors has received funding from Eastern Norway Regional Health Authority (nonprofit, governmental). Four of the authors certify that they (FF, JEM, LN, WF) have received payments or benefits, during the study period, an amount of less than USD 10,000, from Smith & Nephew, Nesbru, Norway, and less than USD 10,000 from Ortomedic, Lysaker, Norway (Ortomedic market orthopaedic implants manufactured by DePuy).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Langslet, E., Frihagen, F., Opland, V. et al. Cemented versus Uncemented Hemiarthroplasty for Displaced Femoral Neck Fractures: 5-year Followup of a Randomized Trial. Clin Orthop Relat Res 472, 1291–1299 (2014). https://doi.org/10.1007/s11999-013-3308-9

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  • DOI: https://doi.org/10.1007/s11999-013-3308-9

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