Use of Cemented Hemiarthroplasty for Femoral Neck Fractures

Abstract

Geriatric femoral neck fractures are common orthopaedic injuries, which are associated with a high morbidity and mortality. Arthroplasty is the optimum treatment for many of these injuries, but debate exists regarding optimal surgical strategy. Multiple recent investigations have demonstrated strong superiority for cemented stems as compared with noncemented fixation with a decreased risk of periprosthetic fracture, shorter length of stay, lower cost, and decreased rate for revision surgery. The main purpose of this article is to refamiliarize the resident or practicing surgeon with cemented arthroplasty by reviewing the basic science of cement, common cementing concerns, and outcomes, as well as by providing tips on cementing technique to ensure safe, simple, and reproducible results.

Figure 1

Images showing the process of cement curing involves four stages: (A) mixing phase (top left), (B) “sticky” or waiting phase (top right), (C) working (bottom left), and (D) hardening (bottom right), with the entire process taking between 10 and 20 minutes.

Figure 2

Flowchart showing the steps of cement application with recommended tips used by the arthroplasty surgeons at our institution.

Figure 3

Postoperative anterior-posterior pelvis (left) and hip (right) radiograph demonstrating a cemented total hip arthroplasty with complete filling of the medullary canal.