title: Displaced intracapsular neck of femur fractures: Outcome of 810 hydroxyapetite coated (HAC) uncemented hemiarthroplasties.
abstract: A Cochrane review influenced new NICE guidelines, which recommended surgeons: Offer cemented implants to patients undergoing surgery with arthroplasty. However our trust routinely uses HAC uncemented stem (Taperloc®, Biomet) hemiarthroplasties. A review of a consecutive series of uncemented HAC stem hemiarthroplasties including measures such as intro-operative complications, mortality and revision surgery. Prospectively collected data between January 2008 and June 2014 was used, with medical record and radiographic reviews performed. 810 consecutive Taperloc uncemented hemiarthroplasty with monopolar heads were performed in 763 patients, with a minimum 12 month follow-up (12-90) follow-up. Mean age 83yrs; 71% female. Meantime to operation was 28.5h. 30day mortality: 4.4% (33/763). One year mortality was 11.2% (89/763). 2.5% (20/810) were admitted on a separate admission with the periprosthetic fracture. 0.6% (5/810) were revised to total hip replacement for subsidence and associated pain. Only 1% (8/810) had intraoperative calcar fractures, all of which were treated with intraoperative cabling with no evidence of clinically relevant subsidence or medium term complications requiring revision surgery within a year. To the author's knowledge this is largest outcome series for modern design uncemented hemiarthroplasty. Our study shows comparable data to cemented hemiarthroplasty but no deaths in the first 2days post-op. Our series also demonstrates a well below average mortality figures which are clearly multifactorial but believe uncemented prosthesis play a role. We believe that uncemented proven stem design hemiarthroplasty remains a safe and good surgical option for displaced intracapsular fractures.
authors.affiliation: Rowley Bristow Orthopaedic Unit, Ashford and St Peters NHS Foundation Trust, Australia. Electronic address: sznawaz@hotmail.co.uk.
authors.forename: S Z
authors.initials: SZ
authors.lastname: Nawaz
authors.affiliation: Rowley Bristow Orthopaedic Unit, Ashford and St Peters NHS Foundation Trust, Australia.
authors.forename: A J
authors.initials: AJ
authors.lastname: Keightley
authors.affiliation: Rowley Bristow Orthopaedic Unit, Ashford and St Peters NHS Foundation Trust, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Desai
authors.affiliation: Rowley Bristow Orthopaedic Unit, Ashford and St Peters NHS Foundation Trust, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Granville-Chapman
authors.affiliation: Rowley Bristow Orthopaedic Unit, Ashford and St Peters NHS Foundation Trust, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Elliott
authors.affiliation: Rowley Bristow Orthopaedic Unit, Ashford and St Peters NHS Foundation Trust, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Newman
authors.affiliation: Rowley Bristow Orthopaedic Unit, Ashford and St Peters NHS Foundation Trust, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Khaleel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D001672:Biocompatible Materials / Q000627:therapeutic use; D001843:Bone Cements / Q000627:therapeutic use; D002484:Cementation / Q000009:adverse effects; D017886:Durapatite / Q000627:therapeutic use*; D005260:Female; D005265:Femoral Neck Fractures / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D062785:Hemiarthroplasty / Q000295:instrumentation / Q000401:mortality; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D057068:Periprosthetic Fractures / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012086:Reoperation / Q000401:mortality / Q000706:statistics & numerical data*; D016896:Treatment Outcome
chemical_list: D001672:Biocompatible Materials; D001843:Bone Cements; D017886:Durapatite
keywords: Hemiarthroplasty; Intracapsular; Neck of femur fracture; Uncemented