Sir,
In response to the reader's comments, we would like to state that we completely agree with his observations that conventional teaching regarding the use of cementless femoral stems has been as per Engh et al.1 and Dorr et al.2
However, we observed a far higher morbidity in the form of acute hypotension and pulmonary embolism following the implantation of cemented stems in elderly patients. After an unfortunate incidence wherein a 78-year-old male patient who underwent cemented bipolar hemiarthroplasty (for fracture neck of femur) went into acute hypotension crisis, and who, despite best intensive care, could not be revived, the senior authors decided to perform cementless arthroplasty in elderly patients who have greater number of comorbid factors, and obviously poorer bone stock. This has been supported by other researchers in their reports.3–6
We have found that these patients do extremely well, without any unpleasant situations on table or immediately postoperative, thereby convincing us to recommend cementless stems for these very elderly patients even with poor bone stock.
REFERENCES
- 1.Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement: The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg Br. 1987;69:45–55. doi: 10.1302/0301-620X.69B1.3818732. [DOI] [PubMed] [Google Scholar]
- 2.Dorr LD, Glousman R, Hoy AL, Vanis R, Chandler R. Treatment of femoral neck fractures with total hip replacement versus cemented and noncemented hemiarthroplasty. J Arthroplasty. 1986;1:21–8. doi: 10.1016/s0883-5403(86)80006-7. [DOI] [PubMed] [Google Scholar]
- 3.McAuley JP, Moore D, Culpepper WJ 2nd, Engh CA. Total hip arthroplasty with porous-coated prosthesis fixed without cement in patients who are sixty-five years of age or older. J Bone Joint Surg Am. 1998;80:1648–55. doi: 10.2106/00004623-199811000-00012. [DOI] [PubMed] [Google Scholar]
- 4.Crachiolo A, 3rd, Severt R, Moreland J. Uncemented total hip arthroplasty in rheumatoid arthritis diseases. Clin Orthop Relat Res. 1992;227:166–74. [PubMed] [Google Scholar]
- 5.Ozturkmen Y, Karamehmetoglu M, Caniklioglu M, Ince Y, Azboy I. Cementless hemiarthroplasty for femoral neck fractures in elderly patients. Indian J Orthop. 2008;42:56–60. doi: 10.4103/0019-5413.38582. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Marya SK, Thukral R, Singh C. Prosthetic replacement in femoral neck fracture in the elderly: Results and review of the literature. Indian J Orthop. 2008;42:61–7. doi: 10.4103/0019-5413.38583. [DOI] [PMC free article] [PubMed] [Google Scholar]