Functional and radiological outcomes between cemented and uncemented partial hip replacement in the elderly

Ajinkya Pravin Darak; Amit Mahajan; Snehal Hedgire

doi:10.18203/issn.2455-4510.IntJResOrthop20260498

Authors

Ajinkya Pravin Darak Department of Orthopaedics, Bharati Vidyapeeth Deemed to be University, Pune, Maharashtra, India
Amit Mahajan Department of Orthopaedics, Bharati Vidyapeeth Deemed to be University, Pune, Maharashtra, India
Snehal Hedgire Department of Orthopaedics, Bharati Vidyapeeth Deemed to be University, Pune, Maharashtra, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20260498

Keywords:

Hemiarthroplasty, Femoral neck fracture, Cemented, Uncemented, Harris hip score, Prosthetic subsidence, Elderly patients, Orthopaedic surgery

Abstract

Background: Hemiarthroplasty (HA) is the treatment of choice for displaced intracapsular femoral neck fractures (FNFs) in elderly patients. However, the optimal method of fixation-cemented or uncemented-remains controversial, particularly in the Indian population. This study aimed to compare the functional and radiological outcomes of cemented versus uncemented HA (UCHA) in elderly patients.

Methods: A retro-prospective comparative study was conducted at a tertiary care centre from January 2021 to September 2024. Sixty-seven patients aged above 60 years with intracapsular FNFs treated with HA were included. Patients were divided into cemented (n=44) and uncemented (n=23) groups. Functional outcome was assessed using the Harris hip score (HHS), and radiological evaluation focused on prosthetic subsidence at 6 months postoperatively. Statistical analysis was performed using SPSS version 29.0 with p<0.05 considered significant.

Results: The mean age of patients was 72.37±8.1 years, with females comprising 55% of the cohort. At 6 months, no statistically significant difference was observed in HHS between the cemented and uncemented groups (p=0.132). Good functional outcomes were seen in 52.6% of the cemented group and 54.5% of the uncemented group. Prosthetic subsidence was higher in the uncemented group (13.04%) compared to the cemented group (2.63%), though the difference was not statistically significant (p=0.135). No major complications were reported.

Conclusions: Cemented and UCHA showed comparable short-term functional outcomes. However, uncemented fixation demonstrated a higher trend toward prosthetic subsidence. Larger studies with longer follow-up recommended.

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References

Cooper C, Campion G, Melton LJ. Hip fractures in the elderly: a worldwide projection. Osteoporos Int. 1992;2(6):285-9. DOI: https://doi.org/10.1007/BF01623184

Liu Y, Chen X, Zhang P, Jiang B. Comparing total hip arthroplasty and hemiarthroplasty for the treatment of displaced femoral neck fracture in the active elderly over 75 years old: a systematic review and meta-analysis of randomized control trials. J Orthop Surg Res. 2020;15(1):215. DOI: https://doi.org/10.1186/s13018-020-01725-3

HEALTH Investigators, Bhandari M, Einhorn TA, Guyatt G, Schemitsch EH, Zura RD, et al. Total hip arthroplasty or hemiarthroplasty for hip fracture. N Engl J Med. 2019;381(23):2199-208. DOI: https://doi.org/10.1056/NEJMoa1906190

Taylor F, Wright M, Zhu M. Hemiarthroplasty of the hip with and without cement: a randomized clinical trial. J Bone Joint Surg Am. 2012;94(7):577-83. DOI: https://doi.org/10.2106/JBJS.K.00006

Li N, Zhong L, Wang C, Xu M, Li W. Cemented versus uncemented hemiarthroplasty for femoral neck fractures in elderly patients: a systematic review and meta-analysis of randomized controlled trials. Medicine. 2020;99(8):e19039. DOI: https://doi.org/10.1097/MD.0000000000019039

Ahn J, Man L-X, Park S, Sodl JF, Esterhai JL. Systematic review of cemented and uncemented hemiarthroplasty outcomes for femoral neck fractures. Clin Orthop Relat Res. 2008;466(10):2513-8. DOI: https://doi.org/10.1007/s11999-008-0368-3

Christie J, Burnett R, Potts HR, Pell AC. Echocardiography of transatrial embolism during cemented and uncemented hemiarthroplasty of the hip. J Bone Joint Surg Br. 1994;76(3):409-12. DOI: https://doi.org/10.1302/0301-620X.76B3.8175843

Parker MI, Pryor G, Gurusamy K. Cemented versus uncemented hemiarthroplasty for intracapsular hip fractures: A randomised controlled trial in 400 patients. J Bone Joint Surg Br. 2010;92(1):116-22. DOI: https://doi.org/10.1302/0301-620X.92B1.22753

Imam MA, Shehata MSA, Elsehili A, Morsi M, Martin A, Shawqi M, et al. Contemporary cemented versus uncemented hemiarthroplasty for the treatment of displaced intracapsular hip fractures: a meta-analysis of forty-two thousand forty-six hips. Int Orthop. 2019;43(7):1715-23. DOI: https://doi.org/10.1007/s00264-019-04325-x

Li T, Zhuang Q, Weng X, Zhou L, Bian Y. Cemented versus uncemented hemiarthroplasty for femoral neck fractures in elderly patients: a meta-analysis. PLoS One. 2013;8(7):e68903. DOI: https://doi.org/10.1371/journal.pone.0068903

Muller ME, Muller ME, Allgower M, Schneider R, Willenegger H. The comprehensive classification of fractures of long bones. In: Manual of Internal Fixation. Berlin: Springer-Verlag. 1990;136-8.

Parker MJ, Gurusamy KS, Azegami S. Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. Cochrane Database Syst Rev. 2010;(6):CD001706.

Raja BS, Gowda AKS, Singh S, Ansari S, Kalia RB, Paul S. Comparison of functional outcomes and complications of cemented vs uncemented total hip arthroplasty in the elderly neck of femur fracture patients: A systematic review and meta-analysis. J Clin Orthop Trauma. 2022;29(101876):101876. DOI: https://doi.org/10.1016/j.jcot.2022.101876

Bhandari M, Swiontkowski M. Management of acute hip fracture. N Engl J Med. 2017;377(21):2053–62. DOI: https://doi.org/10.1056/NEJMcp1611090

Liu B, Li A, Wang J, Wang H, Zhai G, Ma H, et al. Cemented versus uncemented hemiarthroplasty for elderly patients with displaced fracture of the femoral neck: A PRISMA-compliant meta-analysis of randomized controlled trial. Medicine (Baltimore). 2020;99(33):e21731. DOI: https://doi.org/10.1097/MD.0000000000021731

Ekman E, Laaksonen I, Isotalo K, Liukas A, Vahlberg T, Mäkelä K. Cementing does not increase the immediate postoperative risk of death after total hip arthroplasty or hemiarthroplasty: a hospital-based study of 10,677 patients. Acta Orthop. 2019;90(3):270-4. DOI: https://doi.org/10.1080/17453674.2019.1596576

Singh M, Mahindra P, Garg R. Comparison of outcomes in patients undergoing hemiarthroplasty of the hip joint by posterior versus lateral approach. Ind J Orthop Surg. 2024;10(4):309-17. DOI: https://doi.org/10.18231/j.ijos.2024.051

He Y, Tang X, Liao Y, Liu S, Li L, Li P. The Comparison between Cemented and Uncemented Hemiarthroplasty in Patients with FNF: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Orthop Surg. 2023;15(7):1719-29. DOI: https://doi.org/10.1111/os.13716

Patil T, Malve S, Dattu V, Upadhya A. Cemented or uncemented bipolar hemiarthroplasty for FNF in aged patients. Int J Orthop Sci. 2020;6(1):1327-32. DOI: https://doi.org/10.22271/ortho.2020.v6.i1r.2006

Parker MJ, Gurusamy KS, Azegami S. Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. Cochrane Database Syst Rev. 2010;(6):CD001706. DOI: https://doi.org/10.1002/14651858.CD001706.pub4

Sapienza M, Di Via D, Vaccalluzzo MS, Costarella L, Pavone V, Testa G. Comparative analysis of cemented and cementless straight-stem prostheses in hip replacement surgery for elderly patients: A mid-term follow-up study. Prosthesis. 2024;6(3):540-50. DOI: https://doi.org/10.3390/prosthesis6030038

Emery RJ, Broughton NS, Desai K, Bulstrode CJ, Thomas TL. Bipolar hemiarthroplasty for subcapital fracture of the femoral neck. A prospective randomised trial of cemented Thompson and uncemented Moore stems. J Bone Joint Surg Br. 1991;73(2):322-4. DOI: https://doi.org/10.1302/0301-620X.73B2.2005165