Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: A randomized controlled trial with two years follow-up

Abstract

Objective: The aim of this prospective randomized trial was to compare cemented (CHA) and uncemented bipolar hemiarthroplasty (UCH) in patients with femoral neck fractures (FNF). Methods: The study included 158 patients aged ≥76 years who underwent bipolar HA for displaced FNF. Patients were randomized in two groups: the cemented group (CHA, n=79) was treated with cement and the uncemented group (UCH, n=79) without cement. The groups were compared for operating time, blood loss and peroperative morbidity and mortality rates. Results: Both the CHA and the UCH group did not differ significantly in terms of age (86±5 vs. 84±4 years), sex (58.3% male vs. 60.7% female), and comorbidities (p=0.49). The CHA group had a significantly longer operating time (p=0.038) and a greater intraoperative blood loss (p=0.024). In the CHA group there were 8 (10.1%) events of intraoperative drop in the oxygen saturation (SaO2), whereas no such events were noted in the UCH group (p=0.009). Despite no significant difference between these two groups, we found that the CHA group was associated with a higher early postoperative mortality (8.8% in the CHA group versus 3.8% in the UCH group, p=0.009). Intraoperative fracture occurred in two patients (2.5%) of the UCH group. Over a 2-year follow-up period there were no significant differences between the groups regarding the rate of dislocation (p=0.56) or rate of postoperative periprosthetic fracture (p=0.56). There was a trend towards a better postoperative functional recovery at 6 week for the CHA group (77.1±13.1 versus 71.3±16.3), although the mean Harris Hip Score (HHS) at the end of 2 years was comparable (p=0.55). Conclusion: Both CHA and UCH are acceptable methods for treating displaced femoral neck fractures. However, based on our results perioperative cardiovascular disturbances are less frequent and resulting in a potential lower early mortality with UCH. Therefore, UCH is particularly appropriate for elderly patients with pre-existing cardiovascular comorbidities. Level of Evidence: Level II, Randomized Controlled Trial.