Cemented versus uncemented hemiarthroplasty for femoral neck fractures in elderly patients


  • Nikil Sanaba Paramesh Department of Orthopaedics, Dr B R Ambedkar Medical College, Bangalore, Karnataka, India
  • Usman Taufiq Department of Orthopaedics, Dr B R Ambedkar Medical College, Bangalore, Karnataka, India




Femoral neck fractures, Cemented hemiarthoplasty, Uncemented hemiarthoplasty, Bipolar prosthesis


Background: Controversy still exists regarding using cemented or uncemented hemiarthroplasty for femoral neck fractures in elderly patients. The aim of this study is to compare the effectiveness and safety of the two surgical techniques in femoral neck fracture patients over 60 years old.

Methods: We searched PUBMED from inception to December 2012 for relevant randomized controlled trials (RCTs). Outcomes of interest include postoperative hip function, residue pain, complication rates, mortality, reoperation rate, operation time and intraoperative blood loss. Odds ratios (OR) and weighted mean differences (WMD) from each trial were pooled using random-effects model or fixed-effects model given on the heterogeneity of the included studies.

Results: Our control trial involved 132 patients (132 hips) who were eligible for the study. Our results demonstrate that cemented hemiarthroplasty is associated with better postoperative hip function (OR = 0.48, 95% CI, 0.31–0.76; p = 0.002), lower residual pain (OR = 0.43, 95%CI, 0.29–0.64; p<0.0001), less implant-related complications (OR = 0.15, 95%CI, 0.09–0.26; p<0.00001) and longer operation time (WMD = 7.43 min, 95% CI, 5.37–9.49 min; p<0.00001). No significant difference was observed between the two groups in mortality, cardiovascular and cerebrovascular complications, local complications, general complications, reoperation rate and intraoperative blood loss.

Conclusions: Compared with uncemented hemiarthroplasty, the existing evidence indicates that cemented hemiarthroplasty can achieve better hip function, lower residual pain and less implant-related complications with no increased risk of mortality, cardiovascular and cerebrovascular complications, general complications, local complications and reoperation rate in treating elderly patients with femoral neck fractures.


Bhandari M, Devereaux PJ, Tornetta IIIP, Swiontkowski MF, Berry DJ, et al. Operative management of displaced femoral neck fractures in elderly patients. An international survey. J Bone Joint Surg Am. 2005;87:2122–30.

Crossman PT, Khan RJ, MacDowell A, Gardner AC, Reddy NS, Keene GS. A survey of the treatment of displaced intracapsular femoral neck fractures in the UK. Injury 2002;33:383–386.

Clark DI, Ahmed AB, Baxendale BR, Moran CG. Cardiac output during hemiarthroplasty of the hip–a prospective, controlled trial of cemented and uncemented prostheses. J Bone Joint Surg Br. 2001;83:414–418.

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;76:409–412.

Parker MJ, Gurusamy KS. Internal fixation versus arthroplasty for intracapsular proximal femoral fractures in adults. Cochrane Database Syst Rev. 2006;18:CD001708.

Parvizi J, Holiday AD, Ereth MH, Lewallen DG. Sudden death during primary hip arthroplasty. Clin Orthop Relat Res. 1999;369:39–48.

Khan RJK, MacDowell A, Crossman P, Keene GS. Cemented or uncemented hemiarthroplasty for displaced intracapsular fractures of the hip – a systematic review. Injury. 2002;33:13–7.

Luo XP, He SQ, Li ZA, Huang DJ. Systematic review of cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures in older patients. Arch Orthop Trauma Surg. 2012;132:455–63.

Azegami S, Gurusamy KS, Parker MJ. Cemented versus uncemented hemiarthroplasty for hip fractures: a systematic review of randomised controlled trials. Hip Int. 2011;21:509–17.

Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: Treatment by mold arthroplasty. J Bone Jt Surg. 1969;51A:737–755.

11.Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, et al. Assessing the quality of reports of randomized clinical trials:is blinding necessary?. Control Clin Trials 1996;17:1–12.

Sadr B, Arden GP. A comparison of the stability of Proplast-coated and cemented Thompson prostheses in the treatment of subcapital femoral fractures. Injury. 1977;8:234–7.

Lo WH, Chen WM, Huang CK, Chen TH, Chiu FY. Bateman bipolar hemiarthroplasty for displaced interacapsular femoral neck fracture: uncemented versus cemented. Clin Orthop Relat Res. 1994;302:75–82.

Khan RJ, MacDowell A, Crossman P, Datta A, Jallali N. Cemented or uncemented hemiarthroplasty for displaced intracapsular femoral neck fractures. Int Orthop 2002;26: 229–232.

Santini S, Rebeccato A, Bolgan I, Turi G. Hip fractures in elderly patients treated with bipolar hemiarthroplasty: comparison between cemented and cementless implants. J Orthopaed Traumatol 2005;6:80–87.

Livesley PJ, Srivastiva VM, Needoff M, Prince HG, Moulton AM. Use of a hydroxylapatite-coated hemiarthroplasty in the management of subcapital fractures of the femur. Injury 1993;24:236–240.

Parker MI, Pryor G, Gurusamy K. Cemented versus unce-mented hemiarthroplasty for intracapsular hip fractures: A randomized controlled trial in 400 patients. J Bone Joint Surg Br. 2010;92:116–22.

Singh U, Singh K, Waikhom S, Chishti SN, Singh SN,. A comparative study between cemented and uncemented bipolar hemiarthroplasty in the treatment of fresh fracture of femoral neck in the elderly patients. JMS. 2011;1:19–23.

Faraj AA, Branfoot T. Cemented versus uncemented Thompson prostheses: a functional outcome study. Injury. 1999;30:671–675.

Holt EM, Evans RA, Hindley CJ, Metcalfe JW. 1000 femoral neck fractures: the effect of pre-injury mobility and surgical experience on outcome. Injury 1994;25:91–95.

Donaldson AJ, Thomson HE, Harper NJ, Kenny NW. Bone cement implantation syndrome. Br J Anaesth. 2009;102:12–22.

Hossain M, Andrew JG. Is there a difference in perioperative mortality between cemented and uncemented implants in hip fracture surgery? Injury 2012;43:2161–4.

Jameson SS, Jensen CD, Elson DW, Johnson A, Nachtsheim C. Cemented versus cementless hemiarthroplasty for intracapsular neck of femur fracture–a comparison of 60848 matched patients using national data. Injury 2012;44:730–734.

Kesmezacar H, Ayhan E, Unlu MC, Seker A, Karaca S. Predictors of mortality in elderly patients with an intertrochanteric or a femoral neck fracture. J Trauma. 2010;68:153–8.






Original Research Articles