STRONG RECOMMENDATION Two high quality studies (Figved 2009, Taylor 2012) and eleven moderate quality studies (Movrin 2020, Parker 2020, Inngul 2015, Langslet 2014, Deangelis 2012, Santini 2005, Moerman 2017, Chammout 2016, Talsnes 2013, Vidovic 2013, Vidovic 2015) address the question of cemented or uncemented femoral stem arthroplasty for femoral neck fractures, many of them randomized controlled trials. Six studies comprised of one high quality (Taylor 2012) and five moderate quality (Vidovic 2013, Vidovic 2015, Moerman 2017, Inngul 2015, Santini 2005) support cemented femoral stems for short term improved patient reported outcomes. Two studies (Inngul 2015, Taylor 2012) suggested a higher periprosthetic fracture risk in cementless implants. Few studies have demonstrated clear superiority in regard to mortality or medical complications (Parker 2020, Deangelis 2012). Seven studies (Figved 2009, Morvin 2020, Langslet 2014, Chammout 2016, Talsnes 2013, Vidovic 2013, Vodovic 2015) reported higher surgical time and blood loss in cemented implants.
Benefits/Harms of Implementation
Patients who undergo cemented femoral stems may benefit from lower periprosthetic fracture risk and improved short time outcomes while being at risk for increased surgical time and blood loss.
Outcome Importance
Patients undergoing cemented femoral stems will have the benefits of higher short-term patient reported outcomes and lower periprosthetic fracture risk, but with increased surgical time and blood loss during the operation. Postoperative periprosthetic fracture is a serious complication often requiring additional surgery with attendant risks. Surgeon’s familiarity with surgical technique may guide which implant they choose which contributes to the overall variability.
Cost Effectiveness/Resource Utilization
Implant cost varies widely depending on healthcare contracts and geographic location. In general, cemented implants cost less, but utilization may require more resources such as bone cement and cement preparation supplies, as well as operating room staff training.
Acceptability
Acceptability may be variable. However, since 2012, and after the first guidelines of femoral stem fixation were released in 2014, cement fixation for femoral stems has been increasing in the US.
Future Research
High quality, double blinded randomized controlled trials are needed comparing stem fixation in arthroplasty for femoral neck fractures to definitively determine risk of fracture, blood loss and patient outcomes.
- Vidovic, D., Punda, M., Darabos, N., Bekavac-Beslin, M., Bakota, B., Matejcic, A. Regional bone loss following femoral neck fracture: A comparison between cemented and cementless hemiarthroplasty. Injury 2015; 0: S52-6
- Vidovic, D., Matejcic, A., Punda, M., Ivica, M., Tomljenovic, M., Bekavac-Beslin, M., Mijic, A., Bakota, B. Periprosthetic bone loss following hemiarthroplasty: a comparison between cemented and cementless hip prosthesis. Injury 2013; 0: S62-6
- Talsnes, O., Hjelmstedt, F., Pripp, A. H., Reikeras, O., Dahl, O. E. No difference in mortality between cemented and uncemented hemiprosthesis for elderly patients with cervical hip fracture. A prospective randomized study on 334 patients over 75 years. Archives of Orthopaedic & Trauma Surgery 2013; 6: 805-9
- Chammout, G., Muren, O., Laurencikas, E., Bodens, H., Kelly-Pettersson, P., Sjoo, H., Stark, A., Skoldenberg, O. More complications with uncemented than cemented femoral stems in total hip replacement for displaced femoral neck fractures in the elderly: a single-blinded, randomized controlled trial with 69 patients. Acta Orthopaedica 2016; 0: 1â?쳌7
- Moerman, S., Mathijssen, N. M. C., Niesten, D. D., Riedijk, R., Rijnberg, W. J., Koeter, S., Kremers van de Hei, K., Tuinebreijer, W. E., Molenaar, T. L., Nelissen, Rghh, Vochteloo, A. J. H. More complications in uncemented compared to cemented hemiarthroplasty for displaced femoral neck fractures: a randomized controlled trial of 201 patients, with one year follow-up. BMC Musculoskeletal Disorders 2017; 1: 169
- 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; 2: 80-87
- Deangelis, J. P., Ademi, A., Staff, I., Lewis, C. G. Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: a prospective randomized trial with early follow-up. Journal of Orthopaedic Trauma 2012; 3: 135-40
- Langslet, E., Frihagen, F., Opland, V., Madsen, J. E., Nordsletten, L., Figved, W. Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: 5-year followup of a randomized trial. Clinical Orthopaedics & Related Research 2014; 4: 1291-9
- 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 Journal 2015; 11: 1475-80
- Parker, M. J., Cawley, S. Cemented or uncemented hemiarthroplasty for displaced intracapsular fractures of the hip: a randomized trial of 400 patients. Bone & Joint Journal 2020; 1: 11-16
- Movrin, I. Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: A randomized controlled trial with two years follow-up. Acta Orthopaedica et Traumatologica Turcica 2020; 1: 83-88
- Taylor, F., Wright, M., Zhu, M. Hemiarthroplasty of the hip with and without cement: a randomized clinical trial. Journal of Bone & Joint Surgery - American Volume 2012; 7: 577-83
- Figved, W., Opland, V., Frihagen, F., Jervidalo, T., Madsen, J. E., Nordsletten, L. Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures. 2009; 9: 2426-35