title: Hemiarthroplasty using cemented or uncemented stems of proven design: a comparative study.
abstract: National Institute of Clinical Excellence guidelines state that cemented stems with an Orthopaedic Data Evaluation Panel (ODEP) rating of > 3B should be used for hemiarthroplasty when treating an intracapsular fracture of the femoral neck. These recommendations are based on studies in which most, if not all stems, did not hold such a rating. This case-control study compared the outcome of hemiarthroplasty using a cemented (Exeter) or uncemented (Corail) femoral stem. These are the two prostheses most commonly used in hip arthroplasty in the UK. Data were obtained from two centres; most patients had undergone hemiarthroplasty using a cemented Exeter stem (n = 292/412). Patients were matched for all factors that have been shown to influence mortality after an intracapsular fracture of the neck of the femur. Outcome measures included: complications, re-operations and mortality rates at two, seven, 30 and 365 days post-operatively. Comparable outcomes for the two stems were seen. There were more intra-operative complications in the uncemented group (13% vs 0%), but the cemented group had a greater mortality in the early post-operative period (n = 6). There was no overall difference in the rate of re-operation (5%) or death (365 days: 26%) between the two groups at any time post-operatively. This study therefore supports the use of both cemented and uncemented stems of proven design, with an ODEP rating of 10A, in patients with an intracapsular fracture of the neck of the femur.
authors.affiliation: Nuffield Orthopaedic Centre, Botnar Research Centre, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, OX3 7LD, UK.
authors.forename: G
authors.initials: G
authors.lastname: Grammatopoulos
authors.affiliation: Royal Berkshire NHS Foundation Trust, London Road, Reading, Berkshire RG1 5AN, UK.
authors.forename: H A
authors.initials: HA
authors.lastname: Wilson
authors.affiliation: Nuffield Orthopaedic Centre, Botnar Research Centre, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, OX3 7LD, UK.
authors.forename: B J L
authors.initials: BJ
authors.lastname: Kendrick
authors.affiliation: John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK.
authors.forename: E C
authors.initials: EC
authors.lastname: Pulford
authors.affiliation: Royal Berkshire NHS Foundation Trust, London Road, Reading, Berkshire RG1 5AN, UK.
authors.forename: J
authors.initials: J
authors.lastname: Lippett
authors.affiliation: John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK.
authors.forename: M
authors.initials: M
authors.lastname: Deakin
authors.affiliation: Royal Berkshire NHS Foundation Trust, London Road, Reading, Berkshire RG1 5AN, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Andrade
authors.affiliation: John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK.
authors.forename: G
authors.initials: G
authors.lastname: Kambouroglou
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements / Q000627:therapeutic use*; D016022:Case-Control Studies; D002484:Cementation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005265:Femoral Neck Fractures / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D005500:Follow-Up Studies; D062785:Hemiarthroplasty / Q000009:adverse effects / Q000379:methods*; D006622:Hip Prosthesis; D006801:Humans; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D057068:Periprosthetic Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements
keywords: Cemented; Hemiarthroplasty; Neck of femur fracture; Uncemented