Cemented versus uncemented hemiarthroplasty for elderly patients with displaced fracture of the femoral neck

Purpose: With the aging population and increasing average life expectancy, hip fractures are frequently encountered in patients over 55 years of age due to osteoporosis.[1] It is estimated that 6.3 million cases of femoral neck fractures will be seen worldwide in 2050. [2] Hemiarthroplasty is widely used in the treatment of femoral neck fractures in elderly patients.[3] However, there is no clear consensus on the use of cement during these procedures. In this study, we evaluated the results of cemented and cementless hemiarthroplasty in elderly patients. The aim of our study is to retrospectively compare the results of patients who were treated with cemented and cementless partial dentures for femoral neck fractures. Methods: In this retrospective study, we compared the data of 529 patients who were treated with cemented or cementless bipolar hemiarthroplasty due to femoral neck fracture. Patients over 60 years of age with at least 1 year follow-up were included in the study. 353 patients out of 529 received cemented bipolar hemiarthroplasty treatment and 176 patients received cementless bipolar hemiarthroplasty treatment. Demographic information of the patients such as age, gender, ASA score,Spotorno index , duration of surgery, anesthesia methods were noted. Prosthetic and non-prosthetic complications, one-year mortality, and repeat revision surgeries were noted. In our study, the functional scores (Harris hip scores, Womac hip scores, Oxford hip scores) of the patients with at least 1 year follow-up period after the postoperative period (115 patients) were evaluated. There was no statistically significant difference between the groups in the results of Harris hip score, Womac hip score, and Oxford hip score (p=0.514). Results: In our study, 529 patients treated with hemiarthroplasty were included. Of these patients, 353 (66.7%) were in the cemented group and 176 (33.3%) were in the cementless group. Of the 529 patients, 187 (35.3%) were male and 342 (64.7%) were female. The number of female patients in the cemented group was higher than in the other group. There was a statistically significant difference (p=0.009). Out of 529 patients, 206 patients died before completing 1 year. Of these patients, 146 were in the cemented group and 60 were in the uncemented group. Mortality rate of the cemented group was 41.4%, and the mortality rate of the uncemented group was 34.1%. Of 206 deceased patients, 70.9% were in the cemented group and 29.1% were in the uncemented group. There was no statistically significant difference between the groups in terms of one-year mortality (p=0.64). There was no statistically significant difference in prosthesis-related complications such as periprosthetic fracture, periprosthetic infection, dislocation, and reoperation. There was no statistically significant difference in complications such as deep vein thrombosis, myocardial infarction, pulmonary embolism. It differed significantly between patients. Of our 529 patients, 221 (41.8%) of our patients received blood transfusions. Of these, 158 (44.8%) patients were in the cemented group and 63 (35.8%) patients were in the cementless group. There was a statistical difference between the groups(p=0.03). Patients who underwent cemented hemiarthroplasty needed more blood transfusion compared to the other group. Conclusion: We showed that the results between cemented and cementless hemiarthroplasty implants were mostly equivalent, except for the increased blood transfusion rate in the cemented group. Although the rate of intraoperative periprosthetic fractures was higher in the cementless group, there was no statistically significant difference between the groups. Many factors such as the age of the patient, the shape of the fracture, the quality of the bone, and the presence of other additional pathologies in the patient play a role in deciding the treatment method for femoral neck fractures.