Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2025 Jan 24;51(1):73.
doi: 10.1007/s00068-024-02735-0.

Long-term outcomes of cemented compared to uncemented femoral stems in total hip arthroplasty for displaced femoral neck fractures in elderly patients

Michael Axenhus  1 , Ghazi Chammout  2 , Paula Kelly-Pettersson  2 , Sebastian Mukka  3 , Martin Magnéli  2 , Olof Sköldenberg  2
Affiliations
Randomized Controlled Trial

Long-term outcomes of cemented compared to uncemented femoral stems in total hip arthroplasty for displaced femoral neck fractures in elderly patients

Michael Axenhus et al. Eur J Trauma Emerg Surg. .

Abstract

Background: Total hip replacement (THR) is commonly used for active and lucid elderly patients with displaced femoral neck fractures (FNF). Historically, cemented stems have been favoured, demonstrating superior early outcomes. Controversy still exists regarding the use of cemented or uncemented stems in the most active group of patients with FNF and there is a need for extended follow-up studies to assess long-term outcome of cemented and uncemented stem results.

Methods: A 4 and 10-year follow-up was conducted on a single-centre, single-blinded, randomized controlled trial. Patients aged 65-79 years with an acute displaced FNF (Garden III-IV) were included, and surgeries were performed between 2009 and 2014. The study was terminated after an interim analysis indicated that the total number of early hip-related complications was substantially higher in the uncemented group. Baseline and follow-up assessments included hip-related complications, reoperations, health-related quality of life scores, Harris hip score and pain ratings.

Results: In total, 69 patients were randomized. At 4 years, there were 8 complications in the uncemented group and 2 complications in the cemented groups. The uncemented group had several periprosthetic fractures and dislocations necessitating revisions in several cases. From 4 to 10 years, the cemented group showed a single periprosthetic fracture, while none occurred in the uncemented group. The total number of complications during the study period were 8 in the uncemented group and 3 in the cemented group. The median Harris hip score for the uncemented group remained consistent at 81 for both the 4- and 10-year follow-ups. In contrast, the cemented group showed scores of 92 and 93 at the respective 4- and 10-year follow-ups, with no statistically significant difference between the two groups. Health-related quality of life and pain ratings were similar between groups throughout the study.

Conclusion: Our study presents a 10-year follow-up of uncemented femoral stems in THR for elderly FNF patients. Our findings not only underscore the importance of cautious decision-making in selecting patients for uncemented implants, but also highlight that most patients suitable for THR would benefit from a cemented arthroplasty to avoid an increased risk of short-term complications.

Keywords: Cervical hip fractures; Elderly; Femoral; Hip arthroplasty; Hip replacement; RCT.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study adhered to the ethical guidelines outlined in the Helsinki Declaration and received approval from the Ethics Committee of the Karolinska Institute (2009/97 − 31/2). The study has been registered in Clinicaltrials.gov (identifier: NCT02247791). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
CONSORT flow diagram
Fig. 2
Fig. 2
Kaplan-Meier graph showing a 21% risk of reoperation for uncemented femoral stems compared to a 5% risk of reoperations for cemented stems during a 10 year follow up period
Fig. 3
Fig. 3
Median Harris hip score at 4- and 10-year follow up
See this image and copyright information in PMC

References

    1. Chammout GK, Mukka SS, Carlsson T, Neander GF, Stark AWH, Skoldenberg OG. Total hip replacement versus open reduction and internal fixation of displaced femoral neck fractures: a randomized long-term follow-up study. J Bone Joint Surg Am. 2012;94(21):1921–8. - PubMed
    1. Lewis SR, Macey R, Parker MJ, Cook JA, Griffin XL. Arthroplasties for hip fracture in adults. Cochrane Database Syst Rev. 2022;2022(2):CD013410. - PMC - PubMed
    1. Khan RJK, MacDowell A, Crossman P, Datta A, Jallali N, Arch BN, et al. Cemented or uncemented hemiarthroplasty for displaced intracapsular femoral neck fractures. Int Orthop. 2002;26(4):229–32. - PMC - PubMed
    1. Parvizi J, Holiday AD, Ereth MH, Lewallen DG. The Frank Stinchfield Award. Sudden death during primary hip arthroplasty. Clin Orthop Relat Res. 1999;(369):39–48. - PubMed
    1. Kim YH, Oh JH. A comparison of a conventional versus a short, anatomical metaphyseal-fitting cementless femoral stem in the treatment of patients with a fracture of the femoral neck. J Bone Joint Surg Br. 2012;94(6):774–81. - PubMed

Publication types

LinkOut - more resources