A Comparative Study of Cemented Versus Uncemented Hemiarthroplasty in Elderly Patients with Femoral Neck Fractures

Abstract

Femoral neck fracture in older adults poses a significant orthopedic burden with a large morbidity and mortality. Hemiarthroplasty has been a choice of treatment against displaced intracapsular fractures among older patients, but the choice between cemented and uncemented stems has been an issue of clinical controversy. The present prospective, comparative trial has compared 122 elderly patients with dislocated fractures of the femoral neck, who were randomly divided into a cemented hemiarthroplasty and an uncemented hemiarthroplasty group, respectively. There were similarities between baseline demographic and clinical characteristics. During intraoperative, it was found that cemented procedures resulted in an extended operating time with a greater amount of blood loss. But the 24-month postoperative functional outcomes were biased towards cemented hemiarthroplasty, whereby their Harris Hip Scores were superior, Visual Analog Scale measures of pain were inferior, and the frequency of independent ambulation was also higher. However, the uncemented group had a higher total complication rate, mortality and revision rates were not significantly different. Survival patterns between the two cohorts were comparable because Kaplan-Meier showed no difference. The study concludes that even though cemented hemiarthroplasty is related to a more demanding surgery, it provides an excellent functional outcome and a decreased number of mechanical complications. These observations are in favor of cemented stems being used preferentially in elderly patients, but only when they can withstand the stress occurring during the surgery. More multicenter randomized trials with a longer-term follow-up are essential to further examine long-term prosthesis survivability and to more thoroughly validate these findings.