Cemented Versus Cementless Bipolar Hemiarthroplasty for Femoral Neck Fractures in the Elderly

Abstract

⁃ The management of femoral neck fractures remains controversial. Treatment options include a wide variety of internal fixation methods, unipolar or bipolar hemiarthroplasty or total hip replacement. ⁃ We carried out a systematic review of the available literature to detect differences between cemented and cementless fixation of bipolar prostheses in treating femoral neck fractures in patients aged 60 years or older. ⁃ Thirteen studies involving a total of 1561 bipolar hemiarthroplasties (770 cemented and 791 uncemented) were identified. Uncemented hemiarthroplasty was associated with significantly lower blood loss (p < 0.0001), shorter operative time (p < 0.0001), less infection (p = 0.03) and lower risk of heterotopic ossification (p = 0.007). On the other hand, patients with cemented hemiarthroplasty suffered significantly less postoperative thigh pain than those with cementless implantation (p < 0.00001). ⁃ The existing evidence indicates that uncemented bipolar hemiarthroplasty offers shorter operative time, less blood loss, lower local complications and a similar rate of systemic complications and reoperations as compared to cemented implantation.