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Contemporary cemented versus uncemented hemiarthroplasty for the treatment of displaced intracapsular hip fractures: a meta-analysis of forty-two thousand forty-six hips

  • Mohamed A. Imam
  • Mohamed S. A. Shehata
  • Ahmed Elsehili
  • Mahmoud Morsi
  • Alexander MartinEmail author
  • Muhammad Shawq
  • Florian Grubhofer
  • Nish Chirodian
  • Ali Narvani
  • Lukas Ernstbrunner
Original Paper

Abstract

Introduction

Controversy exists regarding the use of cement for hemiarthroplasty to treat displaced intracapsular hip fractures. The aim of this systematic review and meta-analysis was to compare the clinical outcomes between contemporary cemented and contemporary uncemented hemiarthroplasty for the treatment of displaced femoral neck fractures.

Methods

Literature searches of PubMed, Scopus, Web of Science, and Cochrane Central, up to May 2017, were performed. We included randomized controlled trials (RCTs) and observational studies comparing contemporary cemented with contemporary uncemented hemiarthroplasty. Data were pooled as mean difference (MD) or risk ratio (RR) with 95% confidence interval (CI) in a meta-analysis model. Studies with the Thompson and Austin Moore prostheses were excluded.

Results

A total of 29 studies (9 RCTs and 20 observational studies), with a total of 42,046 hips, were included. Meta-analysis showed that the cemented group was associated with fewer periprosthetic fractures (RR = 0.44, 95% CI [0.21, 0.91]), longer operative time (MD = 11.25 min, 95% CI [9.85, 12.66]), more intraoperative blood loss (MD = 68.72 ml, 95% CI [50.76, 86.69]), and higher heterotopic ossification (RR = 1.79, 95% CI [1.11, 2.88]) compared with the uncemented group. Meta-analysis showed no significant difference in terms of post-operative hip function, hip pain, reoperation rate, prosthetic dislocations, aseptic loosening, wound infection, and hospital stay.

Conclusions

This meta-analysis shows that contemporary cemented prostheses have less intra-operative and post-operative fractures, but longer operative time, more intra-operative blood loss, and heterotopic ossifications. Otherwise, there were no significant differences between both groups.

Keywords

Cemented hemiarthroplasty Uncemented hemiarthroplasty Intracapsular hip fractures 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

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Copyright information

© SICOT aisbl 2019

Authors and Affiliations

  • Mohamed A. Imam
    • 1
  • Mohamed S. A. Shehata
    • 2
    • 3
  • Ahmed Elsehili
    • 2
  • Mahmoud Morsi
    • 4
  • Alexander Martin
    • 5
    • 9
    Email author
  • Muhammad Shawq
    • 6
  • Florian Grubhofer
    • 7
  • Nish Chirodian
    • 1
  • Ali Narvani
    • 8
  • Lukas Ernstbrunner
    • 7
  1. 1.Norfolk and Norwich University HospitalsNorwichEngland
  2. 2.Faculty of MedicineZagazig UniversityZagazigEgypt
  3. 3.Medical Research Group of EgyptCairoEgypt
  4. 4.Faculty of Medicine Menoufia UniversityMenoufiaEgypt
  5. 5.Oxford University Hospitals NHS Foundation TrustOxfordUK
  6. 6.Faculty of MedicineAssuit UniversityAsyutEgypt
  7. 7.Balgrist University HospitalUniversity of ZurichZurichSwitzerland
  8. 8.Ashford and St Peter’s NHS TrustAshfordUK
  9. 9.LondonUK

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