Abstract
Introduction
The treatment of displaced femoral neck fractures in elderly patients is under debate. Hemiarthroplasty is a recognised treatment for elderly patients with reduced capacity for mobilisation. Controversy exists around cemented or uncemented implants for hemiarthroplasty in this population. The aim of this study is to investigate outcomes of cemented vs uncemented hemiarthroplasty implants to two years post operation.
Methods
All elderly patients presenting to one institution with a displaced subcapital neck of femur fracture were offered inclusion. One hundred and sixty patients (mean age, 85 years) with acute displaced femoral neck fractures were randomly allocated to be treated with cemented Exeter, or uncemented Zweymüller Alloclassic Hemiarthroplasty. Clinical and radiologic follow-up to two years with the main outcome measurements being pain, mortality, mobility, complications, reoperations, and quality of life using validated scores recorded by a blinded outcome assessor.
Results
Complication rates were more frequent in uncemented implants (p< 0.016). Subsidence and perioperative fracture were significantly higher with uncemented components (p< 0.05). Visual analogue pain scores at rest were not significantly different between each group. Mortality rates were not significantly different at any time point. Oxford Hip scores at 6 weeks favoured cemented implants (p< 0.05). These trends persist but are not significant at later follow-up. Mobility measured by a timed up-and-go score favoured cemented at 6 weeks (p< 0.01), 6 months (p< 0.05) and 1 year (p< 0.005). A trend towards less dependence on walking aids also favoured cemented implants. Multifunctional assessment index and Mini-mental scores were similar in each group.
Conclusion
Cemented hemiarthroplasty provides a better outcome for elderly patients with a displaced femoral neck fracture when compared with uncemented hemiarthroplasty. Complication rates were significantly lower and function and pain scores were improved at multiple time points following surgery.
