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Uncemented Thompson’s hemiarthroplasty: safe, palliative and cost-effective surgery in the infirm patient—a consecutive series of 1445 cases

  • Original Article • HIP - ARTHROPLASTY
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

A Correction to this article was published on 04 October 2019

This article has been updated

Abstract

Background

Guidelines on the management of displaced intracapsular fractures recommend using an Orthopaedic Data Evaluation Panel-rated cemented implant. Prior to the National Institute for Health and Care Excellence guidelines, uncemented implants were commonly used in the UK.

Methods

We retrospectively examined the outcomes of patients with uncemented Thompson’s hemiarthroplasties at our unit, between April 2005 and December 2010. Patients who underwent revision surgery before December 2011 were identified. Implant survival calculation utilised the primary outcome of revision to total hip arthroplasty, revision hemiarthroplasty or excision arthroplasty. Patients who died post-operatively were identified and censored.

Results

A total of 1445 patients received uncemented Thompson’s implant. Patient mean age was 82 years with 76% female. Forty-six (3.2%) patients required revision with 15% performed within 30 days of surgery and 62% within 1 year. Reasons for revision were infection (0.83%), acetabular erosion (0.83%) and loosening (0.62%). Twenty-seven patients (59% of total revisions) underwent revision to THA, 14 (30%) to excision arthroplasty and 5 (11%) to revision hemiarthroplasty. Cumulative survival rate was 98% at 1 year and 95% at 5 years. Thirty-day mortality was 7.1%. One-year mortality was 28.1%.

Conclusion

Current guidelines strongly favour cemented hemiarthroplasty. Recognition that fractured hip patients are a non-homogeneous group is important. In patients with limited life expectancy, an uncemented Thompson is a quick, simple, palliative solution to early mobilisation. Correct surgical technique avoids using cement in this cohort, which is most vulnerable to bone cement implantation syndrome. Cost-effective resource utilisation with an increasingly elderly population remains a surgical responsibility.

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Change history

  • 04 October 2019

    The original version of this article unfortunately contained a mistake. David Morley was not listed among the authors.

  • 04 October 2019

    The original version of this article unfortunately contained a mistake. David Morley was not listed among the authors.

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Acknowledgements

The authors would like to thank Mr. David Morley for his contribution with data collection.

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Authors and Affiliations

  1. Royal Stoke University Hospital, Newcastle Road, Stoke-on-Trent, ST4 6QG, UK

    G. Manoharan, B. D. Chatterton, T. S. Moores & P. J. Roberts

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  1. G. Manoharan
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  2. B. D. Chatterton
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  3. T. S. Moores
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  4. P. J. Roberts
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Correspondence to G. Manoharan.

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Manoharan, G., Chatterton, B.D., Moores, T.S. et al. Uncemented Thompson’s hemiarthroplasty: safe, palliative and cost-effective surgery in the infirm patient—a consecutive series of 1445 cases. Eur J Orthop Surg Traumatol 28, 1103–1109 (2018). https://doi.org/10.1007/s00590-018-2144-8

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  • DOI: https://doi.org/10.1007/s00590-018-2144-8

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