The Effect of Type of Femoral Component Fixation on Mortality and Morbidity after Hip Hemiarthroplasty: A Systematic Review and Meta-Analysis

Abstract

Background: Hip hemiarthroplasty is a well-established treatment of displaced femoral neck fracture, although debate exists over whether cemented or uncemented fixation is superior. Uncemented prostheses have typically been used in younger, healthier patients and cemented prostheses in older patients with less-stable bone. Also, earlier research has suggested that bone cement has cytotoxic effects and may trigger cardiovascular and respiratory adverse events.

Questions/purposes: The aim of this systematic review and meta-analysis was to compare morbidity and mortality rates after cemented and uncemented hemiarthroplasty for the treatment of displaced femoral neck fractures in elderly patients.

Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched seven medical databases for randomized clinical trials and observational studies. We compared cemented and uncemented hemiarthroplasty using the Harris Hip Score (HHS), as well as measures of postoperative pain, mortality, and complications. Data were extracted and pooled as risk ratios or standardized mean difference with their corresponding 95% confidence intervals in a meta-analysis model.

Results: The meta-analysis included 34 studies (12 randomized trials and 22 observational studies), with a total of 42,411 patients. In the pooled estimate, cemented hemiarthroplasty was associated with less risk of postoperative pain than uncemented hemiarthroplasty. There were no significant differences between groups regarding HHS or rates of postoperative mortality, pulmonary embolism, cardiac arrest, myocardial infarction, acute cardiac arrhythmia, or deep venous thrombosis.

Conclusions: While we found that cemented hemiarthroplasty results in less postoperative pain than uncemented hemiarthroplasty in older patients with femoral neck fracture, the lack of significant differences in functional hip scores, mortality, and complications was surprising. Further high-level research is needed.

Keywords: Cemented; Hip hemiarthroplasty; Morbidity; Mortality; Uncemented.

Fig. 1

Flow diagram of study selection

Fig. 2

a Risk-of-bias summary of randomized clinical trials, according to the Cochrane Collaboration’s tool for assessing the risk of bias [33] and b risk-of-bias summary of observational studies, according to the Newcastle–Ottawa scale [66]

Fig. 3

Forest plot showing the standardized mean difference (SMD) in Harris Hip Score between cemented and uncemented hemiarthroplasty (with 95% confidence interval [CI])

Fig. 4

Forest plot showing the risk ratio (RR) of postoperative pain between cemented and uncemented hemiarthroplasty (with 95% confidence interval [CI])

Fig. 5

a Forest plot showing the risk ratio (RR) of mortality at 1 month postoperatively between cemented and uncemented hemiarthroplasty (with 95% confidence interval [CI]); b forest plot showing the RR of mortality at 3 months postoperatively between cemented and uncemented hemiarthroplasty (with 95% CI); c forest plot showing the RR of mortality at 1 year postoperatively between cemented and uncemented hemiarthroplasty (with 95% CI)

Fig. 6

a Forest plot showing the risk ratio (RR) of pulmonary embolism between cemented and uncemented hemiarthroplasty (with 95% confidence interval [CI]); b forest plot showing the RR of myocardial infarction between cemented and uncemented hemiarthroplasty (with 95% CI); c forest plot showing the RR of deep venous thrombosis between cemented and uncemented hemiarthroplasty (with 95% CI)