title: More complications with uncemented than cemented femoral stems in total hip replacement for displaced femoral neck fractures in the elderly.
abstract: Background and purpose - Total hip replacement (THR) is the preferred method for the active and lucid elderly patient with a displaced femoral neck fracture (FNF). Controversy still exists regarding the use of cemented or uncemented stems in these patients. We compared the effectiveness and safety between a modern cemented, and a modern uncemented hydroxyapatite-coated femoral stem in patients 65-79 years of age who were treated with THR for displaced FNF. Patients and methods - In a single-center, single-blinded randomized controlled trial, we included 69 patients, mean age 75 (65-79) and with a displaced FNF (Garden III-IV). 35 patients were randomized to a cemented THR and 34 to a reverse-hybrid THR with an uncemented stem. Primary endpoints were: prevalence of all hip-related complications and health-related quality of life, evaluated with EuroQol-5D (EQ-5D) index up to 2 years after surgery. Secondary outcomes included: overall mortality, general medical complications, and hip function. The patients were followed up at 3, 12, and 24 months. Results - According to the calculation of sample size, 140 patients would be required for the primary endpoints, but the study was stopped when only half of the sample size was included (n = 69). An interim analysis at that time showed that the total number of early hip-related complications was substantially higher in the uncemented group, 9 (among them, 3 dislocations and 4 periprosthetic fractures) as compared to 1 in the cemented group. The mortality and functional outcome scores were similar in the 2 groups. Interpretation - We do not recommend uncemented femoral stems for the treatment of elderly patients with displaced FNFs.
authors.affiliation: a Department of Clinical Sciences at Danderyd Hospital , Karolinska Institutet , Stockholm , Sweden.
authors.forename: Ghazi
authors.initials: G
authors.lastname: Chammout
authors.affiliation: a Department of Clinical Sciences at Danderyd Hospital , Karolinska Institutet , Stockholm , Sweden.
authors.forename: Olle
authors.initials: O
authors.lastname: Muren
authors.affiliation: a Department of Clinical Sciences at Danderyd Hospital , Karolinska Institutet , Stockholm , Sweden.
authors.forename: Evaldas
authors.initials: E
authors.lastname: Laurencikas
authors.affiliation: a Department of Clinical Sciences at Danderyd Hospital , Karolinska Institutet , Stockholm , Sweden.
authors.forename: Henrik
authors.initials: H
authors.lastname: Bodén
authors.affiliation: a Department of Clinical Sciences at Danderyd Hospital , Karolinska Institutet , Stockholm , Sweden.
authors.forename: Paula
authors.initials: P
authors.lastname: Kelly-Pettersson
authors.affiliation: a Department of Clinical Sciences at Danderyd Hospital , Karolinska Institutet , Stockholm , Sweden.
authors.forename: Helene
authors.initials: H
authors.lastname: Sjöö
authors.affiliation: a Department of Clinical Sciences at Danderyd Hospital , Karolinska Institutet , Stockholm , Sweden.
authors.forename: André
authors.initials: A
authors.lastname: Stark
authors.affiliation: a Department of Clinical Sciences at Danderyd Hospital , Karolinska Institutet , Stockholm , Sweden.
authors.forename: Olof
authors.initials: O
authors.lastname: Sköldenberg
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D002484:Cementation / Q000706:statistics & numerical data*; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D006304:Health Status; D006617:Hip Dislocation / Q000453:epidemiology*; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D057068:Periprosthetic Fractures / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D011474:Prosthesis Design; D011788:Quality of Life; D016037:Single-Blind Method; D016896:Treatment Outcome