Cemented versus uncemented hemiarthroplasty for femoral neck fractures in elderly patients

Background: Controversy still exists regarding using cemented or uncemented hemiarthroplasty for femoral neck fractures in elderly patients. The aim of this study is to compare the effectiveness and safety of the two surgical techniques in femoral neck fracture patients over 60 years old.Methods: We searched PUBMED from inception to December 2012 for relevant randomized controlled trials (RCTs). Outcomes of interest include postoperative hip function, residue pain, complication rates, mortality, reoperation rate, operation time and intraoperative blood loss. Odds ratios (OR) and weighted mean differences (WMD) from each trial were pooled using random-effects model or fixed-effects model given on the heterogeneity of the included studies.Results: Our control trial involved 132 patients (132 hips) who were eligible for the study. Our results demonstrate that cemented hemiarthroplasty is associated with better postoperative hip function (OR = 0.48, 95% CI, 0.31–0.76; p = 0.002), lower residual pain (OR = 0.43, 95%CI, 0.29–0.64; p<0.0001), less implant-related complications (OR = 0.15, 95%CI, 0.09–0.26; p<0.00001) and longer operation time (WMD = 7.43 min, 95% CI, 5.37–9.49 min; p<0.00001). No significant difference was observed between the two groups in mortality, cardiovascular and cerebrovascular complications, local complications, general complications, reoperation rate and intraoperative blood loss.Conclusions: Compared with uncemented hemiarthroplasty, the existing evidence indicates that cemented hemiarthroplasty can achieve better hip function, lower residual pain and less implant-related complications with no increased risk of mortality, cardiovascular and cerebrovascular complications, general complications, local complications and reoperation rate in treating elderly patients with femoral neck fractures.

Download Full-text

Comparison of early clinical results for the femoral neck system and cannulated screws in the treatment of unstable femoral neck fractures

10.21203/rs.3.rs-129837/v2 ◽

2021 ◽

Author(s):

Xiaoqiang Zhou ◽

Zhiqiang Li ◽

Renjie Xu ◽

Yuanshi She ◽

Xiangxin Zhang ◽

...

Keyword(s):

Femoral Head ◽

Femoral Neck ◽

Blood Loss ◽

Hospital Stay ◽

Clinical Efficacy ◽

Operation Time ◽

Femoral Neck Fractures ◽

Femoral Head Necrosis ◽

Cannulated Screws ◽

Intraoperative Blood Loss

Abstract Objective: To compare early clinical effects of the femoral neck system (FNS) and three cannulated screws for the treatment of patients with unstable femoral neck fractures.Methods: A retrospective analysis with pair matching of 81 patients who received FNS or cannulated screw internal fixation for Pauwels type-3 femoral neck fracture in our hospital from January 2019 to December 2019 was conducted. Patients who received FNS were the test group, and those who received cannulated screws comprised the control group. Matching requirements were as follows: same sex, similar age and similar body mass index (BMI). A total of 30 pairs were successfully matched, and the average age was 53.84 years. The operation time, intraoperative blood loss, hospital stay, hospitalization cost, postoperative visual analogue scale (VAS) score, time to walking without crutches, Harris score, femoral head necrosis rate and complication rate were compared between the groups.Results: Postoperative re-examination of radiographs showed satisfactory reduction in all patients, and all patients were followed up for 10-22 months. Those in the FNS group had lower postoperative VAS scores, earlier times to walking without crutches, higher Harris scores at the last follow-up and lower complication rates (P<0.05). However, intraoperative blood loss and hospitalization costs were greater in the FNS group (P<0.05). No statistically significant difference in operation time, hospital stay or femoral head necrosis rate was observed between the two groups (P>0.05).Conclusion: For patients with unstable femoral neck fractures, FNS has better clinical efficacy than cannulated screws, though it is also more expensive. The excellent biomechanical performance and clinical efficacy of FNS make it a new choice for the treatment of unstable femoral neck fractures.

Download Full-text

Comparison of Early Clinical Results of Femoral Neck System and Cannulated Screws in the Treatment of Unstable Femoral Neck Fractures

10.21203/rs.3.rs-129837/v1 ◽

2020 ◽

Author(s):

Xiaoqiang Zhou ◽

Zhiqiang Li ◽

Renjie Xu ◽

Yuanshi She ◽

Xiangxin Zhang ◽

...

Keyword(s):

Femoral Head ◽

Femoral Neck ◽

Blood Loss ◽

Femoral Neck Fracture ◽

Complication Rate ◽

Operation Time ◽

Femoral Neck Fractures ◽

Cannulated Screws ◽

Intraoperative Blood Loss ◽

Neck Fracture

Abstract Objective: To compare the early clinical effects of femoral neck system and three cannulated screws in the treatment of patients with unstable femoral neck fractures.Methods: A retrospective analysis was conducted on 81 patients who received FNS or cannulated screws internal fixation for Pauwels Type-3 femoral neck fracture in our hospital from January 2019 to December 2019. A pair-matched clinical research was performed. People who received FNS were test group and people received cannulated screws were control group. Matching requirements were as follows： the same gender, the similar age and the similar BMI. A total of 30 pairs were successfully matched, with an average age of 53.84 years old. The operation time, intraoperative blood loss, hospital stay, hospitalization cost, postoperative VAS score, time walking without crutches, Harris score, femoral head necrosis rate and complication rate were compared between the two groups.Results: Postoperative re-examination of radiographs showed satisfactory reduction in all patients, and all the patients were followed up for 10-22 months. Patients in the FNS group had lower postoperative VAS scores, earlier time to walk without crutches, higher Harris scores at the last follow-up and lower complication rate (P<0.05). However, intraoperative blood loss and hospitalization costs in the FNS group were more（P<0.05）. There was no statistically significant difference in operation time, hospital stay and femoral head necrosis rate between two group (P>0.05).Conclusion: For patients who were unstable femoral neck fracture, FNS has better clinical efficacy than cannulated screws, though FNS is more expensive. The excellent biomechanical performance and clinical efficacy of FNS make it a new choice for the treatment of unstable femoral neck fracture.Fund program: Key medical research project of Jiangsu Health Committee（K2019010）

Download Full-text

Comparison of early clinical results for the femoral neck system and cannulated screws in the treatment of unstable femoral neck fractures

10.21203/rs.3.rs-129837/v3 ◽

2021 ◽

Author(s):

Xiaoqiang Zhou ◽

Zhiqiang Li ◽

Renjie Xu ◽

Yuanshi She ◽

Xiangxin Zhang ◽

...

Keyword(s):

Femoral Head ◽

Femoral Neck ◽

Blood Loss ◽

Hospital Stay ◽

Clinical Efficacy ◽

Operation Time ◽

Femoral Neck Fractures ◽

Femoral Head Necrosis ◽

Cannulated Screws ◽

Intraoperative Blood Loss

Abstract Objective: To compare early clinical effects of the femoral neck system (FNS) and three cannulated screws for the treatment of patients with unstable femoral neck fractures. Methods: A retrospective analysis with pair matching of 81 patients who received FNS or cannulated screw internal fixation for Pauwels type-3 femoral neck fracture in our hospital from January 2019 to December 2019 was conducted. Patients who received FNS were the test group, and those who received cannulated screws comprised the control group. Matching requirements were as follows: same sex, similar age and similar body mass index (BMI). A total of 30 pairs were successfully matched, and the average age was 53.84 years. The operation time, intraoperative blood loss, hospital stay, hospitalization cost, postoperative visual analogue scale (VAS) score, time to walking without crutches, Harris score, femoral head necrosis rate and complication rate were compared between the groups. Results: Postoperative re-examination of radiographs showed satisfactory reduction in all patients, and all patients were followed up for 10-22 months. Those in the FNS group had lower postoperative VAS scores, earlier times to walking without crutches, higher Harris scores at the last follow-up and lower complication rates (P<0.05). However, intraoperative blood loss and hospitalization costs were greater in the FNS group (P<0.05). No statistically significant difference in operation time, hospital stay or femoral head necrosis rate was observed between the two groups (P>0.05). Conclusion: For patients with unstable femoral neck fractures, FNS has better clinical efficacy than cannulated screws, though it is also more expensive. The excellent biomechanical performance and clinical efficacy of FNS make it a new choice for the treatment of unstable femoral neck fractures.

Download Full-text

The choice of screw internal fixation and hemiarthroplasty in the treatment of femoral neck fractures in the elderly: a meta-analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01958-2 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Shuai Cui ◽

Dehui Wang ◽

Xuejie Wang ◽

Zehui Li ◽

Wenlai Guo

Keyword(s):

Femoral Neck ◽

Internal Fixation ◽

Hip Replacement ◽

Operation Time ◽

The Elderly ◽

Reoperation Rate ◽

Femoral Neck Fractures ◽

Controlled Trials ◽

Short Term ◽

Randomized Controlled

Abstract Background Femoral neck fractures are common fractures in the elderly. Common treatment options include internal fixation (IF) and hemiarthroplasty (HA). However, the clinical application of these two options is always controversial due to the potential clinical trauma, postoperative function, early complications, and other factors. Materials and methods Randomized controlled trials and cohort studies comparing screw fixation and hemiarthroplasty in elderly patients with displaced femoral neck fractures were extracted from databases such as PubMed, Web of Science, EMBASE, and Cochrane. The revised Jadad scale or NOS treatment evaluation form was used to evaluate the quality of the included studies. After extracting the data, the standard deviation of continuous data and the relative risk of binary data were used. The operation time, blood loss during operation, EQ-5D (EuroQol-5 Dimension) score, mortality rate, reoperation rate, and postoperative common complications were reviewed using Review Manager software (RevMan 5.3) were compared. Results There were 7 randomized controlled trials and 5 cohort studies. The results showed that the operation time, intraoperative blood loss, and short-term EQ-5D score of the internal fixation group were lower than those of the hemi-hip replacement group, but the reoperation rate was higher. There was no statistically significant difference in mortality and common complications such as deep vein thrombosis, pulmonary embolism, infection, and pressure sores during short-term follow-up. Conclusions In the treatment of elderly femoral neck fractures, the screw internal fixation group has shorter operation time and less intraoperative bleeding, and the perioperative advantage is more obvious. However, the hemi-hip replacement group had more advantages in postoperative functional scoring and reoperation.

Download Full-text

Unipolar versus Bipolar Uncemented Hemiarthroplasty for Elderly Patients with Displaced Intracapsular Femoral Neck Fractures

Journal of Orthopaedic Surgery ◽

10.1177/230949901101900229 ◽

2011 ◽

Vol 19 (2) ◽

pp. 260-260

Author(s):

Sulaiman Alazzawi ◽

Shah Jehan

Keyword(s):

Femoral Neck ◽

Elderly Patients ◽

Femoral Neck Fractures ◽

Uncemented Hemiarthroplasty

Download Full-text

Outcomes of nondisplaced intracapsular femoral neck fractures with internal screw fixation in elderly patients: a systematic review

Hip International ◽

10.5301/hipint.5000532 ◽

2017 ◽

Vol 28 (1) ◽

pp. 18-28 ◽

Cited By ~ 16

Author(s):

Ignacio J. Oñativia ◽

Pablo A.I. Slulittel ◽

Fernando Diaz Dilernia ◽

Juan M. Gonzales Viezcas ◽

Valeria Vietto ◽

...

Keyword(s):

Systematic Review ◽

Mortality Rate ◽

Femoral Neck ◽

Elderly Patients ◽

Internal Fixation ◽

Hip Arthroplasty ◽

The Elderly ◽

Reoperation Rate ◽

Femoral Neck Fractures ◽

Displaced Femoral Neck Fractures

Introduction: Although the preferred treatment for displaced femoral neck fractures in the elderly is hip arthroplasty, the treatment for impacted or undisplaced femoral neck fractures (UFNF) is still a subject of controversy. Our purpose was to systematically review studies of elderly patients with UFNF treated with internal fixation using screws: (i) what is the reported mortality; (ii) what is the reoperation rate; (iii) what are the clinical and radiological outcomes; and (iv) what is the methodological quality of the included studies? Methods: This systematic review was performed through a search of PubMed and the Cochrane database using a structured search algorithm including studies enrolling patients older than 60 years old, with UFNF treated with internal fixation using screws. Our literature search returned 950 studies and 11 were selected for final abstraction. Results: 6 studies reported mortality rate. At 1-year follow-up mortality was reported by 3 studies: 18.8%; 22%, and 19%. At 5 years, 1 study reported mortality rate of 42%. Overall reoperation rate was reported by 9 studies and ranged from 8%-19%, while conversion to hip arthroplasty was performed in the range between 8% and 16% according to 6 studies. Conclusions: Internal fixation with cannulated screws for UFNF in the elderly is a valuable option, although it has substantial reoperation and mortality rates. Further prospective high-quality, randomised controlled trials are required to establish the optimal approach for the treatment of UFNF.

Download Full-text

Intracortical Screw Insertion Plus Limited Open Reduction in Treating Type 31A3 Irreducible Intertrochanteric Fractures in the Elderly

10.21203/rs.3.rs-271287/v1 ◽

2021 ◽

Author(s):

Xiao-wen Huang ◽

Gu-qi Hong ◽

Qiang Zuo ◽

Chen Qun

Keyword(s):

Blood Loss ◽

Elderly Patients ◽

Open Reduction ◽

Operation Time ◽

The Elderly ◽

Fracture Reduction ◽

Intertrochanteric Fractures ◽

X Rays ◽

Intraoperative Blood Loss ◽

Screw Insertion

Abstract Objective: To discuss the clinical efficacy of intracortical screw insertion plus limited open reduction in treating type 31A3 irreducible intertrochanteric fractures in the elderly. Methods: A retrospective analysis was performed for 23 elderly patients with type 31A3 irreducible intertrochanteric fractures (12 males and 11 females, aged 65-89 years old, with an average of 75.6±5.1 years old) who received treatment at the orthopedics department of our hospital from September 2017 to August 2019. After type 31A3 irreducible intertrochanteric fractures were confirmed by intraoperative C-arm, all of these cases received intracortical screw insertion plus limited open reduction in the broken end with intramedullary screw internal fixation. The basic information of surgery, reduction effects, and FRS scores of the hip joint were assessed. Results: All patients were followed up for an average of 13.8 months. The operation time was 53.8±13.6min (40-95min). The intraoperative blood loss was 218.5±28.6ml (170-320ml). The average number of intraoperative X-rays was 22.8±4.6 (18-33). The average time to fracture union was 4.8±0.7 months. The reduction effect was assessed using Kim's fracture reduction evaluation. 20 cases achieved grade I fracture reduction and 3 cases grade II fracture reduction. All of them achieved excellent or good fracture reduction. Upon the last follow-up, the FRS score was 83.6±9.8, which was not significantly different from the FRS score (84.8±10.7) before the fracture (t= 0.397, P= 0.694). Conclusion: With careful preoperative preparation, intracortical screw insertion plus limited open reduction could achieve high-quality fracture reduction and fixation in elderly patients with type 31A3 irreducible intertrochanteric fractures. Good clinical outcomes were achieved without increasing operation time and intraoperative blood loss.

Download Full-text

A PROSPECTIVE STUDY OF FUNCTIONAL OUTCOMES IN CEMENTED VS. UNCEMENTED HEMIARTHROPLASTY IN FEMORAL NECK FRACTURES IN GERIATRIC AGE.

10.36106/paripex/1608537 ◽

2020 ◽

pp. 1-3

Author(s):

Siddhartha Shankar Mohanty ◽

Sunil Kumar Dash ◽

Hemanta Kumar Bamidi ◽

Kishore Chandra Dash

Keyword(s):

Femoral Neck ◽

Blood Loss ◽

Prospective Study ◽

Functional Outcomes ◽

Operative Time ◽

Study Groups ◽

Femoral Neck Fractures ◽

Uncemented Hemiarthroplasty ◽

Uncemented Group

Introduction: The optimum treatment choice for femoral neck fractures is often contested. In this study, we aimed to compare the functional outcome in geriatric patients who underwent either cemented or uncemented hemiarthroplasty in our department. Methods: This prospective study included patients who were scheduled to undergo hemiarthroplasty for femoral neck fracture in the Department of Orthopaedics, Hi-Tech Medical College, Bhubaneswar, Odisha. Two study groups were made. One group had patients who underwent uncemented hemiarthroplasty and the second group had patients who underwent cemented hemiarhtroplasty. Surgery related information was collected from the operative notes of the surgeon. Post-operative complications, Visual Analogue Scale (VAS) scores and Harris Hip Score (HHS) were noted during the follow up period. Results: There were 30 patients in the uncemented group and 31 in the cemented group. All the baseline demographic and clinical variables were similar in both the study groups. Mean intraoperative blood loss and operative time was significantly higher among the patients who underwent cemented hemiarthroplasty as compared to uncemented group. Mean VAS score at the first month and sixth month follow up was significantly higher among patients in the uncemented group as compared to cemented group. Functional outcome was not significantly different according to the HHS performed 6 months post-operatively. Conclusions: Patients in the cemented group had a higher intra-operative blood loss and longer operative time. However, the pain score on the VAS were significantly lower at first and sixth month follow up. Functional outcomes were not significantly different between the two study groups.

Download Full-text

Historically, did Cemented Thompson perform better than uncemented Austin Moore hemiarthroplasty for femoral neck fractures? A meta-analysis of available evidence

SICOT-J ◽

10.1051/sicotj/2019031 ◽

2019 ◽

Vol 5 ◽

pp. 33 ◽

Cited By ~ 2

Author(s):

Mohamed S.A. Shehata ◽

Ahmed Abdelal ◽

Sami Salahia ◽

Hussien Ahmed ◽

Muhammad Shawqi ◽

...

Keyword(s):

Femoral Neck ◽

Hospital Stay ◽

Meta Analysis ◽

Reoperation Rate ◽

Femoral Neck Fractures ◽

Hip Pain ◽

Displaced Femoral Neck Fractures ◽

Hip Function ◽

Austin Moore ◽

Better Than

Introduction: Thompson and Austin Moore prostheses have been commonly used in hemiarthroplasties for displaced femoral neck fractures. There has been considerable debate about which of these prostheses is preferred. The purpose of this meta-analysis was to compare historical data for clinical outcomes of cemented Thompson and uncemented Austin Moore hemiarthroplasty in displaced femoral neck fractures. Methods: We searched Medline via PubMed, Cochrane Central, Scopus, Ovid and Web of Science for relevant articles up to February 2019. The included outcomes measured were hip function, hip pain, implant-related complications, surgical complications, reoperation rate and hospital stay. The data were pooled as risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI) between the two compared groups in a meta-analysis model. Results: Ten studies (four RCTs and six observational studies) with a total of 4378 patients were included in the final analysis. The pooled RR showed that the Thompson group was associated with a lower incidence of postoperative hip pain (RR = 0.66, 95% CI [0.54, 0.80]), lesser reoperation rate (RR = 0.46, 95% CI [0.24, 0.88]), lesser intraoperative fractures (RR = 0.15, 95% CI [0.09, 0.25]), but a longer operative time (MD = 12.04 min, 95% CI [2.08, 22.00]) in comparison to the Austin Moore group. The effect estimate did not favour either group in terms of hip function, periprosthetic fractures, prosthetic dislocations, wound infection, mortality and hospital stay. Conclusion: Evidence shows that Thompson hemiarthroplasty is better than Austin Moore hemiarthroplasty in terms of hip pain, reoperation rate and intraoperative fractures. Whereas the postoperative hip function is equivalent, these results could be considered when assessing the outcomes in modern hips.

Download Full-text