Acetabular options

The Comparison between Cemented and Uncemented Hemiarthroplasty in Patients with Femoral Neck Fractures: A Systematic Review and Meta-analysis of Randomized Controlled Trials

BACKGROUND

Hemiarthroplasty is the standard treatment for patients with femoral neck fractures (FNFs). Controversy exists over the use of bone cement in hip fractures treated with hemiarthroplasty.

OBJECTIVE

We performed an updated systematic review and meta-analysis to compare cemented and uncemented hemiarthroplasty in patients with femoral neck fractures.

METHODS

A literature review was conducted using Cochrane Library, ScienceDirect, PubMed, Embase, Medline, Web of Science, CNKI, VIP, Wang Fang, and Sino Med databases. Studies comparing cemented with uncemented hemiarthroplasty for FNFs in elderly patients up to June 2022 were included. Data were extracted, meta-analyzed, and pooled as risk ratios (RRs) and weighted mean differences (WMDs) with a 95% confidence interval (95% CI).

RESULTS

Twenty-four RCTs involving 3471 patients (1749 cement; 1722 uncemented) were analyzed. Patients with cemented intervention had better outcomes regarding hip function, pain, and complications. Significant differences were found in terms of HHS at 6 weeks (WMD 12.5; 95% CI 6.0-17.0; P < 0.001), 3 months (WMD 3.3; 95% CI 1.6-5.0; P < 0.001), 4 months (WMD 7.3; 95% CI 3.4-11.2; P < 0.001), and 6 months (WMD 4.6; 95% CI 3.3-5.8; P < 0.001) postoperatively. Patients with cemented hemiarthroplasty had lower rates of pain (RR 0.59; 95% CI 0.39-0.9; P = 0.013), prosthetic fracture (RR 0.24; 95% CI 0.16-0.38; P < 0.001), subsidence/loosening (RR 0.29; 95% CI 0.11-0.78; P = 0.014), revisions (RR 0.59; 95% CI 0.40-0.89; P = 0.012), and pressure ulcers (RR 0.43; 95% CI 0.23-0.82; P = 0.01) at the expense of longer surgery time (WMD 7.87; 95% CI 5.71-10.02; P < 0.001).

CONCLUSION

This meta-analysis demonstrated that patients with cemented hemiarthroplasty had better results in hip function and pain relief and lower complication rates at the expense of prolonged surgery time. Cemented hemiarthroplasty is recommended based on our findings.

Migration of the acetabular component: effect of cement pressurization and significance of early radiolucency: a randomized 5-year study using radiostereometry

BACKGROUND

Cementing technique is a crucial factor in prosthesis fixation. No randomized studies have been published, however, comparing the outcome of conventional fingerpacking with the outcome of pressurization of the cement prior to cup insertion.

PATIENTS AND METHODS

We randomized 50 THAs to either fingerpacking or sequential pressurization (including individual pressurization of each anchorage hole) and followed the patients with RSA for 5 years. The penetration of cement into the anchorage holes was measured on digital radiographs. Postoperative radiolucent lines around the cup were correlated to later RSA results. For clinical evaluation, we used SF-36 and HHS.

RESULTS

The pressurized group of THAs was more stable regarding changes in inclination. We found no other difference in the migratory behavior. The cement penetration into the anchorage holes was deeper with the pressurization technique than with fingerpacking. For the whole group taken together, there was a strong relation between the presence of radiolucent lines as measured on the postoperative radiograph and later migration observed by RSA at 2 and 5 years.

INTERPRETATION

Pressurization of the cement produced better cement penetration and increased the cup stability in terms of changes in inclination. Early findings of radiolucent lines can predict later unfavorable cup migration.

The role of cemented sockets in 2004: is there one?

Cement fixation of the acetabular cup in total hip arthroplasty (THA) has evolved through multiple generations of cement technology. Whereas cement technology has produced improvements in cemented femoral fixation, the cemented socket still produces inconsistent results. Even with our current knowledge that cemented cups require exposure of cancellous bone, a clean and dry socket, and adequate bony coverage of the cup, surgeons such as myself are unable to control radiolucency at the bone-cement interface. The technical difficulty of cementing the acetabular cup has led to the increasing prevalence of cementless acetabular cups. Although cementless fixation has resulted in increased incidence of osteolysis, the surgical procedure is less technically demanding, and the long-term mechanical fixation results have been more consistent. Given the experiential learning curve that most orthopedic surgeons face with cemented fixation of the acetabular cup component, the role of the cemented socket in THA today is limited.