Abstract
Purpose
The neck of femur fractures in the elderly is a global concern. These fractures impair the quality of living and add to morbidity and mortality. A Multitude of treatment options for the same. This systematic review focuses on evaluating outcomes between cemented and uncemented total hip replacement in the elderly population with neck of femur fractures.
Material and methods
The search was conducted in databases PubMed, Embase, Scopus, open grey, and Cochrane following PRISMA guidelines. The studies fulfilling the inclusion criteria were included, scrutinized for data analysis, and also quality appraisal of all the included studies was conducted to be included in this article.
Results
A total of 7 studies were included (2 RCT, 5 retrospective studies) comprising 1171 THRs. Data analysis showed a higher HHS in cemented compared to uncemented(p < 0.001). The uncemented group had a significantly higher rate of revision, dislocation, and periprosthetic fracture compared to cemented group(p < 0.001). However, VAS score, loosening rates, and heterotopic ossification were similar in both statistically insignificant groups.
Conclusion
Choosing between cemented and uncemented techniques had been a controversy with lesser data due to higher morbidity and mortality. This systematic review provides information regarding functional outcomes and complications in both groups. The cemented group had better outcomes and lesser complications which should be preferred in elderly patients as the conclusion of this study. However, a larger RCT with better follow-up is still required.
Level of evidence
Level I, systematic review and meta-analysis.
Keywords: Total hip arthroplasty, Cemented, Uncemented, Cementless, Neck of femur fracture
1. Introduction
Proximal femur fractures are one of the most common fractures in the elderly population. The neck of femur (NOF) fracture accounts for 90% of the fractures in the elderly in the emergency setting.1 Trivial trauma in such a population cohort is the main etiological factor for fractures of this region along with the vertebral column. The mortality and morbidity of these fractures are expected to be higher as the age increases.2, 3, 4 In such patients, mobilizing as early as possible is the mainstay of treatment to be provided. Total hip arthroplasty (THA) in the setting of these fragility fractures in such a population group is well documented.5 THA offers improved functional outcomes and better health quotients in comparison to hemiarthroplasty (HA).1
One often accepts the functional outcomes of hemiarthroplasty owing to medical comorbidities or sedentary lifestyles. THA offers itself as an option for treatment in patients with higher expectations and increased mobility. On analyzing the data of the England and Wales joint registry, it was seen that the results of total hip replacements for acute fracture NOF were comparable to the results of total hip replacements for other indications.6 The femoral stems used are mainly either cemented or cementless. In the elderly population, cemented fixation had remained a regular procedure opted over the cementless one. However, using cement in the implant fixation in the elderly is often associated with higher rates of bone cement implantation syndrome, which causes an increased risk of perioperative mortality.7 Uncemented or cementless fixation of the femoral stem had been widely studied in comparison to the cemented fixation and outcomes have been found promising and equivalent.8 Both cemented and cementless fixation have advantages as well as disadvantages but which one is superior is still a debatable question. In a network metanalysis in acute femoral neck fractures, Zhang et al. noted uncemented bipolar HA (hemiarthroplasty) patients had lower infection incidence whereas cemented unipolar HA had low reoperation rates.9 However, there exists a paucity of evidence to comment on the use of cemented or uncemented THR in the elderly population with femoral neck fractures. With time, as the population above the age of 65 years is increasing, the number of cases of proximal femur fractures is expected to rise. The purpose of this systematic review is to answer the ongoing debate of “cemented vs. cementless total hip arthroplasty in displaced femoral neck fractures” in the elderly with neck of femur fractures.
2. Material and methods
PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) were followed for the literature search. The literature search was done on various data platforms like PubMed, Embase, Scopus, open grey, and Cochrane, using multiple search terms or derivatives until 13th April 2021. The search was done using the terms “THR”, “THA”, “Total Hip Arthroplasty”, “Total hip replacement” “Total hip arthroplasty”, “Cemented”, “Uncemented”, “Cementless”, “Femoral neck fracture”, “Neck of femur fracture”, “Proximal femur fracture”, “Fragility fracture”, “Traumatic neck fracture”. To increase the efficiency of the search outcomes, Boolean operators “AND” or “OR” were utilized in various combinations possible. Relevant Mesh terms “fractures, bone”, “femoral neck fracture”, “femoral fracture”, ärthroplasty, replacement, hip”, and “cementation” were also searched to increase the number of results. With this, all relevant abstracts and bibliographies were extracted. Full-text articles were obtained after screening the title and abstract which fulfilled the inclusion criteria. The search was conducted by authors (B.S.R and S.S). Any disagreements were discussed and the senior author (R.B.K) took the final decision.
2.1. Eligibility criteria
All the studies in the English language which fulfilled the inclusion criteria were included. These include 1) mean age of cohort >65 years 2) displaced fracture neck of femur 3) had at least one below-mentioned outcome measure comparing between cemented and uncemented/cementless THR. The exclusion criteria included articles in the cadaveric studies, biomechanical studies, case reports, case series, or posters.
2.2. Quality appraisal
All the studies were assessed by two reviewers (S.A and A.K.S.G.) and a quality appraisal of every article was done. MINORS tool was used to evaluate the quality of each study. It includes a set of 12 questions for comparative studies. It includes the aim of the study and analyses up to adequate statistical data with each question giving 0, 1, or 2 points according to fulfillment of question by study. The quality appraisal for all the studies was done by the 3rd and the 4th authors and in case of any disagreements, it was reassessed by the third author and finalized.
2.3. Data extraction and statistical analysis
The data were extracted by the 3rd, 4th, and 5th authors and included demographic details, procedure details, type of fracture, the approach used for the procedure, comorbidities, blood loss in both groups, outcome measures like Harris Hip Score on final follow up, complications (periprosthetic fracture, pain, heterotopic ossification). Guidelines of the Oxford Centre for Evidence-based Medicine were followed to find out the level of evidence of all the studies included in the review. Continuous data were expressed as mean and standard deviation and the dichotomous data as events and total. The mean difference (MD) with a 95% confidence interval is reported for continuous variables and the odds ratio (OR) for dichotomous variables.
The data was extracted using Microsoft Excel software and a meta-analysis was performed using Revman 5.3 software. The random-effects model was utilized assuming that there is a mean specific population effect size about which the study-specific effect varies, taking into account the heterogeneity between the studies including the study designs and it provides a conservative evaluation than the fixed effects for the significance of association.10
3. Results
Of the 1,812 citations identified through literature searches, 161 were assessed for eligibility (Fig. 1). A total of nine studies met our criteria for qualitative synthesis. Seven studies met all of our inclusion criteria.1,11, 12, 13, 14, 15, 16 These included 2 RCTs and 5 retrospective studies. Two studies have been used considered and described in our results section describing heterotropic ossification and acetabular wear-out.17,18
Fig. 1.
Flow chart of selection process.
A total of 1171 THRs were included in these seven studies among which 528 were males and 589 were females. 568 patients underwent cemented prosthesis versus 549 who had an uncemented prosthesis. The mean age of the patients was 72 years and 71.56 in the cemented and uncemented groups respectively. The mean postoperative follow-up was 5.22 (range 1–10.3) years. The study characteristics and patient characteristics are listed in Table 1. Two studies included dual mobility cup prostheses, with the rest making use of standard cemented and uncemented prostheses. Various implant types reported by these studies are listed in Table 2.
Table 1.
Characteristics of included studies.
| Author | Study design | Country | Sample size | Age (years), M/F | Follow up | Comparison | MINORScore |
|---|---|---|---|---|---|---|---|
| Clement ND 2021 | RCT | United Kingdom | C - 25 UC -25 |
C-73.3, 5/20 UC-74.7, 5/20 |
72 months | Cemented THR vs Uncemented THR | 24 |
| Uriarte I 2021 | Retrospective | Spain | C - 44 UC -61 |
C- 76.3, 13/31 UC- 75.0, 12/49 |
4.1 years (SD 1.8) | Cemented cup vs Uncemented cups in THR | 22 |
| Mao S 2020 | Retrospective | China | C - 132 UC - 136 |
C-67.43, 68/64 UC-67.65, 65/71 |
C-62.25 m UC-63.43 m |
Cemented THR vs Uncemented THR | 21 |
| Zhang C 2020 | Retrospective | China | C – 112 UC - 114 |
C- 68.75, 52/60 UC- 69.02, 50/64 |
C-10.33 UC-10.21 (years) |
Cemented THR vs Uncemented THR | 22 |
| Liu T 2019 | Retrospective | China | C - 164 UC -160 |
C-68.75, 92/72 UC-68.61, 97/63 |
C -73.25m UC - 73.16 m |
Cemented vs uncemented stem in THR | 20 |
| Tabori-Jensen 2017 | Retrospective | Denmark | C - 56, (stem: 90) UC -73, (stem: 39) |
C-76.5, 25/48 UC-74, 22/51 |
2.83(1.0–7.7) years | Cemented cup vs uncemented cup | 17 |
| Chammout G 2017 | RCT | Sweden | C - 35 UC - 34 |
C- 73, 10/25 UC- 72, 12/22 |
2 years | Cemented vs Uncemented stems in THR | 24 |
Footnote: C- cemented; UC: uncemented; THR: Total Hip Replacement; m: months; SD: Standard deviation; M/F: Male/female; MINORS (methodological quality of non-randomized surgical studies).
Table 2.
Implant characteristics.
| Author | Uncemented | Cemented |
|---|---|---|
| Clement ND 2021 | uncemented Corail stem and a Pinnacle cup (Depuy, Warsaw, Indiana). | cemented Exeter stem with a contemporary cemented polyethylene cup (Stryker Orthopaedics, Mahwah, New Jersey, USA). |
| Uriate I 2021 | a press-fit cup (Novae Sunfit TH; Serf, Décines, France), made of stainless steel with a bilayer coating of porous plasma sprayed titanium and hydroxyapatite | stainless steel cemented cup (Novae Stick; Serf, Décines, France). |
| Zhang C 2020 | 75: Corail4 Reflection uncemented2. 39 Filler5 Trident,1 Igloo5 |
54: Exeter, Exeter Elite, IP/SP1. 32: Spectron EF2 Contemporary, Marathon. 26: Lubinus SP23 Exeter X3 Rimfit1 |
| Mao S 2020 | Taperloc stem (Biomet, Warsaw, IN) combined with a ram-extruded bar stock polyethylene cup (GUR 415; Hoechst Celanese Corp, Houston,TX). | Exeter Universal stem combined with the All-poly cup (Stryker, Mahwah, NJ) |
| Liu T 2019 | Stryker Orthopaedics, Mahwah, SM, USA; acetabular component: standard-device, Stryker, Mahwah, NJ | Stryker Orthopaedics, Mahwah, SM, USA; acetabular component: standard-device, Stryker, Mahwah, NJ |
| Tabori-Jensen 2017 | Saturne® DM cups with 28 mm chrome-cobalt heads in UHMWPE. Cementless cups (n = 73) were hydroxyapatite coated. The Corail® HA-coated stem (n = 34) was used in most cementless cases (DePuy Synthes, Warsaw, IN, USA), and the porous coated Synergy® cementless stem was used in (n = 5) cases (Smith & Nephew). | The Exeter® highly-polished stem (Stryker) with vacuum mixed palacos® R + G bone cement were used in all cemented stem cases (n = 90) (Zimmer). |
| Chammout G 2017 | The Bi-Metric stem (Biomet, Warsaw, IN) was used in the uncemented group | The modular CPT (Zimmer, Warsaw, IN) was used in the cemented group |
Footnote: USA: United states of America; NJ: New Jersey; UHMWPE: Ultra High Molecular Weight Polyethylene; CPT: Collarless, Polished, tapered design.
3.1. Harris hip score <5 years
Five studies compared HHS in the short term (<5years).1,11,13, 14, 15 The HHS was found to be higher in the cemented group which was statistically significant (MD = 2.53; CI = −0.459 to −0.48; P = 0.02) (Fig. 2).
Fig. 2.
Forest plot of comparison: functional outcome (short term and long term).
3.2. Harris hip score >5 years
Four studies compared HHS between groups of more than 5 years.1,11,13,15 The HHS score was seen to be more in the cemented group in comparison with the uncemented group and was statistically significant (MD = 5.20; CI = −6.68 to −3.73; P < 0.00001) (Figure-2).
3.3. VAS score
Two studies reported results of pain scores.13,14 Similar pain scores were reported in the two groups there was no statistically significant difference between them (OR = 0.11, 95%CI = −0.76 to 0.99; P = 0.80) (Fig. 3).
Fig. 3.
Forest plot of comparison: for pain score.
3.3.1. Revision rates-
Four included studies reported revision rate.1,11,14,15 The uncemented THRs had a higher statistically significant revision rate (OR = 2.60; 95% CI = 1.61 to 4.20; P < 0.00001) with nonsignificant homogeneity (I2 = 0%) for this outcome (Fig. 4).
Fig. 4.
Forest plot of comparison: various complication rates.
3.3.2. Radiological loosening
Three studies reported complications in both cemented and uncemented groups.1,11,12 The odds ratio (OR) of radiographic evidence of loosening was 2.27, (95% CI, 1.39 to 3.71; P,0.001), indicating that loosening rates in the cemented group were lower than that in the uncemented group (Fig. 4).
3.3.3. Periprosthetic fractures
The uncemented THR group had a considerably higher rate of periprosthetic fractures as compared to the cemented THRs (44 out of 335 vs 15 out of 356 respectively). This finding was consistent in all 4 studies which reported them and were statistically significant (OR = 2.95; 95% CI = 1.62 to 5.36; P = 0.0004)(Fig. 4).1,11,13,14
3.3.4. Dislocations
Three studies reported the dislocation rate in the two groups.1,11,14 All studies showed higher rates of dislocations in the uncemented group (23/330 vs 12/331 respectively) which is not statistically significant (95% CI = 0.96 to 4.04; P = 0.07) (Fig. 4).
3.3.5. Heterotrophic ossification
Three studies reported the heterotrophic ossification between the groups.1,11,14 Similar rates of heterotrophic ossification were seen in both cemented and uncemented THRs which did not attain significance level (OR = 0.92; 95% CI = 0. 60 to 1.40; P = 0.68) (Fig. 4).
3.3.6. Quality assessment
The Minors score for individual studies is reported in Table 1 which consists of 12 questionnaires that have scores of 0,1 and 2 for each question with the ideal score being 16 for non-comparative studies and 24 for comparative studies. The funnel plots of the included studies are depicted in Fig. 5 and showed minimal heterogenicity.
Fig. 5.
Funnel plots of included studies depicting HHS <5 years and radiological loosening.
4. Discussion
With the global aging demographics, the incidence of femoral neck fracture has become an increasingly serious problem for senior patients. THR in comparison to hemiarthroplasty for the treatment of displaced intracapsular neck of femur fractures bids the potential of a better post-operative hip-specific functional outcome and overall generic health.19,20 However, controversy surrounds the use of cemented prostheses for a long time now. Some surgeons prefer to use the uncemented prosthesis since it can reduce operation time, intraoperative blood loss, and perioperative cardiovascular complications, while others believe that the cemented technique can attain better postoperative hip-specific function recovery and fewer prosthesis related complications. This meta-analysis was therefore conducted to compare the outcome in the cemented and uncemented THRs for elderly patients with a displaced intracapsular fracture neck of the femur.
In the literature, there is a paucity of evidence to suggest the use of cemented or uncemented THR in the elderly neck of femur fracture patients. In a network meta-analysis by Zhang et al., uncemented THR had the highest rate of dislocation compared to other means of treatment. But, the network meta-analysis had no direct arms comparing uncemented and cemented THR.9 Similarly, a meta-analysis by Parker MJ et al. analyzed the Arthroplasties (with and without bone cement) for proximal femoral fractures in adults but, the review had no comparison of cemented versus uncemented THR.21 To the best of our knowledge, the current systematic review is the first one to assess the outcomes and complications between cemented and uncemented THR in elderly patients with neck of femur fractures.
Our meta-analysis provides evidence that overall, cemented THR was superior to uncemented THR in terms of both better functional outcomes as pointed out in most of the retrospective studies, and also fewer complication rates as suggested by the RCTs. In addition, there was no advantage in using uncemented stems for any of the other endpoints. Better postoperative functional recovery was suggested by the fact that HHS in the cemented THR group was significantly better both in the short term (<5years) and long term (>5 years) indicating consistently better joint function recovery in the cemented group. This was consistent in all the studies which compared the HHS in the two groups.1,11,13, 14, 15 Pain scores in both the groups were similar and there was no significant difference between them with low heterogeneity (P = 0.80, I 2 = 0%). The uncemented group had a significantly higher complication rate such as radiographic loosening, periprosthetic fractures, dislocation, and heterotrophic ossification. The revision rates of the uncemented prosthesis were significantly higher (66/444 vs 27/441) which was seen consistently in all studies reporting revision rates.1,11,14,15
This analysis suggests that cemented fixation gives favorable results in elderly patients with neck or femur fractures, as demonstrated by all studies included in the analysis. In contrast, some previous studies did not find a difference in the overall mortality rates, complications, and functional and radiological results, which were similar in patients undergoing an uncemented with those undergoing a cemented THA performed for hip fracture.22 A possible explanation for this is the high mean age of the patients included in the analysis (>70 years in both groups). This may favor higher complications and revisions in the uncemented THR group as described in previous studies.23, 24, 25
Lower volume of blood loss is an expected potential advantage of the uncemented relative to cemented THA owing to the shorter operative time.26 However, this is complicated by the fact that due to the increased rate of intraoperative complications in the uncemented THA group, there is an increase in the operative time and blood loss. In the study by Chammout et al., there were 4 periprosthetic fractures in the uncemented THR group (n = 34), compared to 1 in the cemented group (n = 35).14 Abdulkarim et al. noted that cemented THR is similar if not superior to uncemented THR and provides better short-term clinical outcomes in patients more than age 18 years undergoing THR (but excluded arthroplasty for trauma).27
With the introduction of modern hydroxyapatite-coated implants, uncemented fixation has increased in popularity yet the majority of surgeons prefer cemented fixation as is seen in the Swedish hip arthroplasty registry, cemented stems have primarily been used for patients with femoral neck fractures.28 Late-onset post-operative periprosthetic fractures and revisions due to failure of osseointegration, are also risk factors to be considered when using uncemented stems in the elderly.29 For the late periprosthetic fractures, there is evidence from different national joint registries that uncemented stems constitute a risk factor for such a complication.28,30
Although cemented as well as uncemented THRs have been the standard accepted method of replacement surgery there remains no definite consensus on which device should be used for femoral neck fractures.31
Despite the measures having minimal drawbacks, several limitations in our work are still recognized. As in any meta-analysis, there may be publication bias, incomplete ascertainment of studies, and errors in data extraction. Also, there are certain potential predictors of outcome such as race, rehabilitation program, and activity level which could not be explored, due to very limited information on these variables among the studies that were included. All attempts to minimize errors in data extraction through cross-checking all quantitative information were made by two of the authors. All sources of data, that we could identify from a comprehensive literature search, without any restriction regarding language, to find studies for inclusion were used. Moreover, since the studies included are of different designs there may be biases. Ideally, one would strive for a meta-analysis of RCTs. But, the lack of studies in the field makes it improbable at present. A Large prospective study involving multi-centric data is required to validate the results of our systematic review.
5. Conclusions
To date, some controversy still exists about the use of cemented vs uncemented THRs for femoral neck fractures in elderly patients. Individual patient factors should be fully evaluated, along with the patient's age, activity level, and life expectancy, to achieve optimal clinical efficacy. The results reported in this study support a growing body of evidence in favor of cemented total hip prosthesis as compared to uncemented THRs in fracture neck of femur in the elderly subset of patients. Based on these results, we would recommend the use of cemented THR for the treatment of displaced femoral neck fractures in elderly patients.
Ethics approval
Approval from the institutional ethics committee was not required for this review article.
Consent to participate
No participants were enrolled for this review article. Hence, informed consent was not required.
Consent to publish
All authors have read the final prepared draft of the manuscript and approve this version, in its current format if considered further for publication.
Financial support and sponsorship
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Authors contribution
B.S.R - Planning of study, literature search, writing the manuscript, quality assessment of the included studies. A.K.S.G – Literature search, writing the manuscript, quality assessment of the included studies. S.S- Literature search, outcome assessment, manuscript preparation. S.A - Data management, outcome assessment, quality assessment of the included studies. R.B.K - Planning of study, quality assessment of the included studies, writing and revising the manuscript S.P- quality assessment of the included studies, writing and revising the manuscript.
Availability of data and materials
All included studies used in this systematic review and meta-analysis are available online. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Data regarding this study is not available in any electronic databases.
Declaration of competing interest
All authors declare that they do not have any competing interest, concerning this research, authorship, and/or publication of this article.
Contributor Information
Balgovind S. Raja, Email: balgovindsraja@gmail.com.
Aditya K.S. Gowda, Email: adityajr.orth@aiimsrishikesh.edu.in.
Sukhmin Singh, Email: sukhmin92@gmail.com.
Sajid Ansari, Email: sajidans89@gmail.com.
Roop Bhushan Kalia, Email: roopkalia2003@yahoo.com.
Souvik Paul, Email: 1990.souvik@gmail.com.
References
- 1.Mao S., Chen B., Zhu Y., et al. Cemented versus uncemented total hip replacement for femoral neck fractures in elderly patients: a retrospective, multicentre study with a mean 5-year follow-up. J Orthop Surg Res. 2020;15(1):447. doi: 10.1186/s13018-020-01980-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Hadjimichael A.C. Hip fractures in the elderly without osteoporosis. J Frailty Sarcopenia Falls. 2018;3(1):8–12. doi: 10.22540/JFSF-03-008. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Cauley J.A. Osteoporosis: fracture epidemiology update 2016. Curr Opin Rheumatol. 2017;29(2):150–156. doi: 10.1097/BOR.0000000000000365. [DOI] [PubMed] [Google Scholar]
- 4.Knobe M., Pape H.C. Anchorage strategies in geriatric hip fracture management. Innovative Surgical Sciences. 2016;1(2):73–78. doi: 10.1515/iss-2016-0034. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Miller B.J., Callaghan J.J., Cram P., Karam M., Marsh J.L., Noiseux N.O. Changing trends in the treatment of femoral neck fractures: a review of the american board of orthopaedic surgery database. J Bone Joint Surg Am. 2014;96(17):e149. doi: 10.2106/JBJS.M.01122. [DOI] [PubMed] [Google Scholar]
- 6.Stafford G.H., Charman S.C., Borroff M.J., Newell C., Tucker J.K. Total hip replacement for the treatment of acute femoral neck fractures: results from the National Joint Registry of England and Wales at 3-5 years after surgery. Ann R Coll Surg Engl. 2012;94(3):193–198. doi: 10.1308/003588412X13171221589720. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Tsai M.C., Ng Y.Y., Chen W.M., Tsai S.W., Wu S.C. The effects of cement fixation on survival in elderly patients with hip hemiarthroplasty: a nationwide cohort study. BMC Musculoskelet Disord. 2019;20(1):628. doi: 10.1186/s12891-019-3013-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Zhou X., Chen M., Yu W., Han G., Ye J., Zhuang J. Uncemented versus cemented total hip arthroplasty for displaced femoral neck fractures in elderly patients with osteoporosis: a retrospective analysis. J Int Med Res. 2020;48(8) doi: 10.1177/0300060520944663. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Zhang B.F., Wang P.F., Huang H., Cong Y.X., Wang H., Zhuang Y. Interventions for treating displaced intracapsular femoral neck fractures in the elderly: a Bayesian network meta-analysis of randomized controlled trials. Sci Rep. 2017;7(1):13103. doi: 10.1038/s41598-017-13377-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Fleiss J.L. The statistical basis of meta-analysis. Stat Methods Med Res. 1993;2(2):121–145. doi: 10.1177/096228029300200202. [DOI] [PubMed] [Google Scholar]
- 11.Liu T., Hua X., Yu W., et al. Long-term follow-up outcomes for patients undergoing primary total hip arthroplasty with uncemented versus cemented femoral components: a retrospective observational study with a 5-year minimum follow-up. J Orthop Surg Res. 2019;14(1):371. doi: 10.1186/s13018-019-1415-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Jensen ST. Evaluation of Dual-Mobility Total Hip Arthroplasty in Elderly Patients with Femoral Neck Fracture or Hip Osteoarthritis. :173.
- 13.Clement N.D., van der Linden M., Keating J.F. Higher rate of complications with uncemented compared to cemented total hip arthroplasty for displaced intracapsular hip fractures: a randomised controlled trial of 50 patients. Eur J Orthop Surg Traumatol. 2021;31(3):587–594. doi: 10.1007/s00590-020-02808-x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Chammout G., Muren O., Laurencikas E., et al. More complications with uncemented than cemented femoral stems in total hip replacement for displaced femoral neck fractures in the elderly. Acta Orthop. 2017;88(2):145–151. doi: 10.1080/17453674.2016.1262687. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Zhang C., Chen M., Yu W., Han X., Ye J., Zhuang J. Long-term survival after cemented versus uncemented total hip arthroplasty for treatment of acute femoral neck fracture: a retrospective study with a mean 10-year follow-up. J Int Med Res. 2020;48(9) doi: 10.1177/0300060520941974. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Uriarte I., Moreta J., Jimenez I., Legarreta M.J., Martínez de Los Mozos J.L. Dual-mobility cups in total hip arthroplasty after femoral neck fractures: a retrospective study comparing outcomes between cemented and cementless fixation. Injury. 2021;52(6):1467–1472. doi: 10.1016/j.injury.2020.12.032. [DOI] [PubMed] [Google Scholar]
- 17.Barenius B., Inngul C., Alagic Z., Enocson A. A randomized controlled trial of cemented versus cementless arthroplasty in patients with a displaced femoral neck fracture: a four-year follow-up. Bone Joint J. 2018;100-B(8):1087–1093. doi: 10.1302/0301-620X.100B8.BJJ-2017-1593.R1. [DOI] [PubMed] [Google Scholar]
- 18.Inngul C., Blomfeldt R., Ponzer S., Enocson A. Cemented versus uncemented arthroplasty in patients with a displaced fracture of the femoral neck: a randomised controlled trial. Bone Joint J. 2015;97-B(11):1475–1480. doi: 10.1302/0301-620X.97B11.36248. [DOI] [PubMed] [Google Scholar]
- 19.Keating J.F., Grant A., Masson M., Scott N.W., Forbes J.F. Randomized comparison of reduction and fixation, bipolar hemiarthroplasty, and total hip arthroplasty. Treatment of displaced intracapsular hip fractures in healthy older patients. J Bone Joint Surg Am. 2006;88(2):249–260. doi: 10.2106/JBJS.E.00215. [DOI] [PubMed] [Google Scholar]
- 20.Lewis D.P., Wæver D., Thorninger R., Donnelly W.J. Hemiarthroplasty vs total hip arthroplasty for the management of displaced neck of femur fractures: a systematic review and meta-analysis. J Arthroplasty. 2019;34(8):1837–1843. doi: 10.1016/j.arth.2019.03.070. e2. [DOI] [PubMed] [Google Scholar]
- 21.Parker M.J. 2021. Randomised Controlled Trial of Cemented Hemiarthroplasty versus Uncemented Furlong Hemiarthroplasty. clinicaltrials.Gov.https://clinicaltrials.gov/ct2/show/NCT02998034 [Google Scholar]
- 22.Gavaskar A.S., Tummala N.C., Subramanian M. Cemented or cementless THA in patients over 80 years with fracture neck of femur: a prospective comparative trial. Musculoskelet Surg. 2014;98(3):205–208. doi: 10.1007/s12306-013-0296-6. [DOI] [PubMed] [Google Scholar]
- 23.Eskelinen A., Remes V., Helenius I., Pulkkinen P., Nevalainen J., Paavolainen P. Uncemented total hip arthroplasty for primary osteoarthritis in young patients: a mid-to long-term follow-up study from the Finnish Arthroplasty Register. Acta Orthop. 2006;77(1):57–70. doi: 10.1080/17453670610045704. [DOI] [PubMed] [Google Scholar]
- 24.Hooper G.J., Rothwell A.G., Stringer M., Frampton C. Revision following cemented and uncemented primary total hip replacement: a seven-year analysis from the New Zealand Joint Registry. J Bone Joint Surg Br. 2009;91(4):451–458. doi: 10.1302/0301-620X.91B4.21363. [DOI] [PubMed] [Google Scholar]
- 25.Kennedy J.W., Johnston L., Cochrane L., Boscainos P.J. Outcomes of total hip arthroplasty in the octogenarian population. Surgeon. 2013;11(4):199–204. doi: 10.1016/j.surge.2012.12.005. [DOI] [PubMed] [Google Scholar]
- 26.Andersen MF, Jakobsen T, Bensen AS, Krarup N. Lower reoperation rate for cemented femoral stem than for uncemented femoral stem in primary total hip arthroplasty following a displaced femoral neck fracture. SICOT J. 1:26. doi:10.1051/sicotj/2015028. [DOI] [PMC free article] [PubMed]
- 27.Abdulkarim A., Ellanti P., Motterlini N., Fahey T., O'Byrne J.M. Cemented versus uncemented fixation in total hip replacement: a systematic review and meta-analysis of randomized controlled trials. Orthop Rev (Pavia) 2013;5(1):e8. doi: 10.4081/or.2013.e8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28.Leonardsson O., Kärrholm J., Åkesson K., Garellick G., Rogmark C. Higher risk of reoperation for bipolar and uncemented hemiarthroplasty. Acta Orthop. 2012;83(5):459–466. doi: 10.3109/17453674.2012.727076. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29.Lindahl H., Malchau H., Herberts P., Garellick G. Periprosthetic femoral fractures classification and demographics of 1049 periprosthetic femoral fractures from the Swedish National Hip Arthroplasty Register. J Arthroplasty. 2005;20(7):857–865. doi: 10.1016/j.arth.2005.02.001. [DOI] [PubMed] [Google Scholar]
- 30.Rogmark C., Fenstad A.M., Leonardsson O., et al. Posterior approach and uncemented stems increases the risk of reoperation after hemiarthroplasties in elderly hip fracture patients. Acta Orthop. 2014;85(1):18–25. doi: 10.3109/17453674.2014.885356. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 31.Medda S., Snoap T., Carroll E.A. Treatment of young femoral neck fractures. J Orthop Trauma. 2019;33(Suppl 1):S1–S6. doi: 10.1097/BOT.0000000000001369. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
All included studies used in this systematic review and meta-analysis are available online. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Data regarding this study is not available in any electronic databases.