title: Cemented versus cementless hemiarthroplasty for intracapsular neck of femur fracture--a comparison of 60,848 matched patients using national data.
abstract: National guidelines recommend cemented hemiarthroplasty for intracapsular fractured neck of femur (NOF), based on evidence of less pain, better mobility and lower costs. We aimed to compare complications following cemented and cementless implants, using the national hospital episode statistics (HES) database in England. Dislocation, revision, return to theatre and medical complications were extracted for all patients with NOF fracture who underwent hemiarthroplasty between January 2005 and December 2008. To make a 'like for like' comparison all 30,424 patients with a cementless implant were matched to 30,424 cemented implants (from a total of 42,838) in terms of age, sex and Charlson co-morbidity score. In the cementless group, 18-month revision (1.62% versus 0.57% (OR 2.90, p<0.001)), 4-year revision (2.45% versus 1.11% (OR 2.28, p<0.001)) and 30-day chest infection (8.14% versus 7.23% (OR 1.14, p=0.028)) were significantly higher. Four-year dislocation rate was higher in cemented implants (0.60% versus 0.26% (OR 0.45, p<0.001)). No significant differences were seen in return to theatre or other medical complications. In this national analysis of matched patients mid-term revision and perioperative chest infection was significantly higher in the cementless group. This supports the published evidence and national guidelines recommending cement fixation of hemiarthroplasty.
authors.affiliation: National Orthopaedic Research and Surgical Outcomes, Newcastle, UK; Northern Deanery Trauma & Orthopaedic Training Scheme, Waterfront 4, Goldcrest Way, Newcastle, UK.
authors.forename: Simon S
authors.initials: SS
authors.lastname: Jameson
authors.forename: Cyrus D
authors.initials: CD
authors.lastname: Jensen
authors.forename: David W
authors.initials: DW
authors.lastname: Elson
authors.forename: Andrew
authors.initials: A
authors.lastname: Johnson
authors.forename: Christopher
authors.initials: C
authors.lastname: Nachtsheim
authors.forename: Amar
authors.initials: A
authors.lastname: Rangan
authors.forename: Scott D
authors.initials: SD
authors.lastname: Muller
authors.forename: Mike R
authors.initials: MR
authors.lastname: Reed
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D005260:Female; D005265:Femoral Neck Fractures / Q000453:epidemiology* / Q000601:surgery*; D062785:Hemiarthroplasty / Q000379:methods*; D006617:Hip Dislocation / Q000209:etiology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010146:Pain / Q000209:etiology; D017410:Practice Guidelines as Topic; D012042:Registries; D012086:Reoperation; D015996:Survival Rate; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D001843:Bone Cements