Cemented Femoral Stems
Moderate evidence supports the preferential use of cemented femoral stems in patients undergoing arthroplasty for femoral neck fractures.
Rationale
Eight moderate strength (Deangelis et al 84, Figved et al 85, Taylor et al 86,Santini et al87, Lennox et al88, Parker et al 89, Sonne-Holm et al 90, Singh et al 91) studies address the question of cemented or press fit arthroplasty in the elderly. Randomized controlled trials have largely failed to demonstrate differences (Deangelis et al 84, Figved et al 85), with the exception of fracture risk, which appears to be higher in press fit stems (Taylor et al 86). This remains an infrequent event in other studies. In general, both approaches yielded acceptable functional results with low complication rates.
Risks and Harms of Implementing this Recommendation
As with all surgical procedures, there are potential risks and benefits which are unlikely to be affected by this recommendation.
Future Research
Long term studies designed specifically to elucidate potential differences in postoperative fracture risk between cemented or press fit stems are needed.
Risks and Harms of Implementing this Recommendation
As with all surgical procedures, there are potential risks and benefits which are unlikely to be affected by this recommendation.
Future Research
Long term studies designed specifically to elucidate potential differences in postoperative fracture risk between cemented or press fit stems are needed.
- (84) Deangelis JP, Ademi A, Staff I, Lewis CG. Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: a prospective randomized trial with early follow-up. J Orthop Trauma 2012;26(3):135-140.
- (85) Figved W, Opland V, Frihagen F, Jervidalo T, Madsen JE, Nordsletten L. Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures. Clin Orthop Relat Res 2009;467(9):2426-2435.
- (86) Taylor F, Wright M, Zhu M. Hemiarthroplasty of the Hip with and without Cement: A Randomized Clinical Trial. J Bone Joint Surg Am 2012;999(2):577-583.
- (87) Santini S, Rebeccato A, Bolgan I, Turi G. Hip fractures in elderly patients treated with bipolar hemiarthroplasty: Comparison between cemented and cementless implants. Journal of Orthopaedics and Traumatology 2005;6(2):80-87.
- (88) Lennox IA, McLauchlan J. Comparing the mortality and morbidity of cemented and uncemented hemiarthroplasties. Injury 1993;24(3):185-186.
- (89) 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):116-122.
- (90) Sonne HS, Walter S, Jensen JS. Moore hemi-arthroplasty with an without bone cement in femoral neck fractures. A clinical controlled trial. Acta Orthop Scand 1982;53(6):953-956.
- (91) Singh GK, Deshmukh RG. Uncemented Austin-Moore and cemented Thompson unipolar hemiarthroplasty for displaced fracture neck of femur--comparison of complications and patient satisfaction. Injury 2006;37(2):169-174.