No difference in mortality between cemented and uncemented hemiprosthesis for elderly patients with cervical hip fracture. A prospective randomized study on 334 patients over 75 years

Abstract

Introduction: Laboratory and human mechanical studies indicated that chemical substances in bone cement had toxic and prothrombotic effects. Impaction of cement added a mechanical trauma to the reaming and broaching procedure and contributed to a substantial local and systemic thrombin generation. Case reports and materials have indicated bone cement as the immediate trigger of cardiorespiratory and vascular dysfunction, occasionally fatal, and described as the bone cement implantation syndrome. In spite of this knowledge, bone cement has gained popularity and is widely used for prosthesis fixation, possibly due to a lack of clinical evidence supporting the basic science indicating bone cement as a mortality risk factor.

Method: This is a prospective, randomized study comparing cemented and non cemented hemiprosthesis on patients suffering a dislocated cervical hip fracture. Perioperative characteristics and 1 year mortality differences between the groups were estimated.

Patients: Hundred and thirty-four patients over 75 years were enrolled from two hospitals in Norway. Average age was 84 years, 75 % were female and 60 % had symptomatic comorbidities.

Results: We find no difference in mortality between cemented and uncemented hemiprosthesis up to 1 year (HR 0.77, 95 % CI 0.51-1.18, p = 0.233). However, statistically significant reduced operation time and blood loss were found in the non-cemented group. (mean difference of 13 min, 95 % CI 4-22, p = 0.004 and 92 ml 95 % CI 3-181, p = 0.043, respectively).

Conclusion: Installation of non-cemented hemiprostheses in elderly with hip fracture may have benefits perioperatively regarding operation time and bleeding, and do not seem to influence 1 year mortality relative to cemented implants.