Cemented versus uncemented total hip replacement for femoral neck fractures in elderly patients: A retrospective, multicentre study with a mean 5-year follow-up

Abstract

Background: Cemented or uncemented total hip replacement (CTR or UTR) for femoral neck fractures (AO/OTA type 31B/C) is a relatively common procedure in elderly individuals. The recent literature is limited regarding long-term outcomes following CTR versus UTR in the Asian population. Methods: Using our institutional database, we performed long-term outcome analysis on 268 patients with femoral neck fractures (AO/OTA type 31B/C) who had undergone a primary UTR or CTR (CTR: n = 132, mean age, 67.43 ± 6.51 years; UTR: n = 136, mean age, 67.65 ± 6.13 years) during 2007-2014, and these patients were followed until 2019. Follow-up occurred 1, 3, 6, and 12 months postoperatively and yearly thereafter. The primary endpoint was the Harris hip score (HHS); the secondary endpoint was the incidence of orthopaedic complications. Results: The mean follow-up time was 62.5 months (range, 50.1-76.1 months). At the final follow-up, the HHS was 79.39 ± 16.92 vs 74.18 ± 17.55 (CTR vs UTR, respectively, p = 0.011). Between-group significant differences were observed regarding the incidence of prosthesis revision, prosthesis loosening, and periprosthetic fracture (7.6% [95% CI, 6.4-8.2] for CTR vs 16.9% [95% CI, 14.7-17.3] for UTR, p = 0.020; 9.8% [95% CI, 8.3-10.7] for CTR vs 19.9% [95% CI, 18.2-20.9] for UTR, p = 0.022; 5.3% [95% CI, 4.4-6.7] for CTR vs 13.2% [95% CI, 12.1-13.8] for UTR, p = 0.026, respectively). Conclusion: CTR showed superiority to UTR by improving the HHS and decreasing the incidence of orthopaedic complications. Our findings need to be confirmed in a prospective, randomized controlled study to verify whether they can be applicable to a broader population.