Prasoon Kumar1, Rajesh Kumar Rajnish2, Deepak Neradi2, Vishal Kumar2, Saurabh Agarwal2, Sameer Aggarwal2. 1. Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India. drprasoonksingh@gmail.com. 2. Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India.
Abstract
BACKGROUND: Management of fractures of neck of femur in the elderly is largely joint sacrificing, with hemiarthroplasties being the most common entity used. Cemented and uncemented, both the techniques, are universally accepted; however, the former has been more time tested, despite its theoretical disadvantage in the form of cement embolism leading to intra-operative complications. Uncemented stems have been ever evolving with newer designs to increase incorporation, stability and durability. They have their own reported sets of disadvantages like subsidence and fractures. However, overall there is no established gold standard out of the two. OBJECTIVE: The present systematic review and meta-analysis of current literature was conducted, so as to determine the superiority of one technique over the other by comparing the primary outcomes like hip function, residual pain, local and general complications and mortality. Additionally secondary outcomes like duration of surgery, blood loss and re-operations were analysed as well. METHODOLOGY: Three databases of PubMed, EMBASE and SCOPUS were searched for relevant articles of last 10 years that directly compare uncemented and cemented hemiarthroplasties, and based on our inclusion and exclusion criteria, article selection was done. RESULTS: We analysed a total of six randomised controlled studies dated from 2008 to 2017. PRIMARY OUTCOMES: There was a significant difference in post-operative ability to ambulate at 1 year, between 2 groups with odds ratio 0.45 (95% CI 0.29-0.67, p = 0.0001) favouring cemented hemiarthroplasty. Prosthesis-related complications like fractures and subsidence and general complications like lung complications were more in uncemented group. Mortality at 1 year was more in cemented group. SECONDARY OUTCOMES: Mean surgical time was lesser in uncemented cases. There was no difference in blood loss and re-operation rates. CONCLUSION: Cementing techniques are here to stay, until a better, durable and more stable uncemented stem evolves, that could lessen the complications related to uncemented surgeries and match the cemented implants in pain relief and ambulation.
BACKGROUND: Management of fractures of neck of femur in the elderly is largely joint sacrificing, with hemiarthroplasties being the most common entity used. Cemented and uncemented, both the techniques, are universally accepted; however, the former has been more time tested, despite its theoretical disadvantage in the form of cement embolism leading to intra-operative complications. Uncemented stems have been ever evolving with newer designs to increase incorporation, stability and durability. They have their own reported sets of disadvantages like subsidence and fractures. However, overall there is no established gold standard out of the two. OBJECTIVE: The present systematic review and meta-analysis of current literature was conducted, so as to determine the superiority of one technique over the other by comparing the primary outcomes like hip function, residual pain, local and general complications and mortality. Additionally secondary outcomes like duration of surgery, blood loss and re-operations were analysed as well. METHODOLOGY: Three databases of PubMed, EMBASE and SCOPUS were searched for relevant articles of last 10 years that directly compare uncemented and cemented hemiarthroplasties, and based on our inclusion and exclusion criteria, article selection was done. RESULTS: We analysed a total of six randomised controlled studies dated from 2008 to 2017. PRIMARY OUTCOMES: There was a significant difference in post-operative ability to ambulate at 1 year, between 2 groups with odds ratio 0.45 (95% CI 0.29-0.67, p = 0.0001) favouring cemented hemiarthroplasty. Prosthesis-related complications like fractures and subsidence and general complications like lung complications were more in uncemented group. Mortality at 1 year was more in cemented group. SECONDARY OUTCOMES: Mean surgical time was lesser in uncemented cases. There was no difference in blood loss and re-operation rates. CONCLUSION: Cementing techniques are here to stay, until a better, durable and more stable uncemented stem evolves, that could lessen the complications related to uncemented surgeries and match the cemented implants in pain relief and ambulation.
Authors: Kendra Kibble; Sarah C Peck; Harsh R Parikh; Ilexa Flagstad; Tiffany Gorman; A Bandele Okelana; Brian P Cunningham Journal: Geriatr Orthop Surg Rehabil Date: 2020-06-10
Authors: Taranjit Tung; Trevor C Gascoyne; Elly Trepman; Carole H Stipelman; Sarah Tran; Eric R Bohm; Colin D Burnell; David R Hedden; Thomas R Turgeon Journal: Can J Surg Date: 2022-08-12 Impact factor: 2.840