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Hemiarthroplasty for neck of femur fractures: to cement or not? A systematic review of literature and meta-analysis

  • Prasoon KumarEmail author
  • Rajesh Kumar Rajnish
  • Deepak Neradi
  • Vishal Kumar
  • Saurabh Agarwal
  • Sameer Aggarwal
General Review • HIP - FRACTURES

Abstract

Background

Management of fractures of neck of femur in the elderly is largely joint sacrificing, with hemiarthroplasties being the most common entity used. Cemented and uncemented, both the techniques, are universally accepted; however, the former has been more time tested, despite its theoretical disadvantage in the form of cement embolism leading to intra-operative complications. Uncemented stems have been ever evolving with newer designs to increase incorporation, stability and durability. They have their own reported sets of disadvantages like subsidence and fractures. However, overall there is no established gold standard out of the two.

Objective

The present systematic review and meta-analysis of current literature was conducted, so as to determine the superiority of one technique over the other by comparing the primary outcomes like hip function, residual pain, local and general complications and mortality. Additionally secondary outcomes like duration of surgery, blood loss and re-operations were analysed as well.

Methodology

Three databases of PubMed, EMBASE and SCOPUS were searched for relevant articles of last 10 years that directly compare uncemented and cemented hemiarthroplasties, and based on our inclusion and exclusion criteria, article selection was done.

Results

We analysed a total of six randomised controlled studies dated from 2008 to 2017.

Primary outcomes

There was a significant difference in post-operative ability to ambulate at 1 year, between 2 groups with odds ratio 0.45 (95% CI 0.29–0.67, p = 0.0001) favouring cemented hemiarthroplasty. Prosthesis-related complications like fractures and subsidence and general complications like lung complications were more in uncemented group. Mortality at 1 year was more in cemented group.

Secondary outcomes

Mean surgical time was lesser in uncemented cases. There was no difference in blood loss and re-operation rates.

Conclusion

Cementing techniques are here to stay, until a better, durable and more stable uncemented stem evolves, that could lessen the complications related to uncemented surgeries and match the cemented implants in pain relief and ambulation.

Keywords

Hemiarthroplasty Cemented Uncemented Outcomes Neck femur fractures NOF Complications 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of OrthopaedicsPost Graduate Institute of Medical Education and ResearchChandigarhIndia

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