Is cemented bipolar hemiarthroplasty a safe treatment for femoral neck fracture in elderly patients?

Effect of nHA-Coated Femoral Stem Prosthesis Combined with Platelet-Rich Plasma in Hemi Hip Replacement of Femoral Neck Fracture in the Elderly

Purpose

This study investigated the efficacy of nanohydroxyapatite- (nHA-) coated biological prosthesis combined with platelet-rich plasma (PRP) in hemi hip replacement of femoral neck fracture (FNF) in the elderly.

Methods

From September 2018 to September 2021, 102 elderly patients with FNF treated in our hospital were chosen and divided into two groups according to different intervention methods. Fifty-one patients in the bone cement group were treated with bone cement prosthesis, and the rest 51 patients in the observation group were treated with nHA biological prosthesis combined with PRP in hemi hip replacement. In order to explore the osteogenic effect of nHA and PRP, osteoblasts were cultured.

Results

It was found that nHA and PRP could both effectively promote the proliferation of osteoblasts and improve their mineralization ability, especially when used in combination. In the course of clinical therapy, we found that the use of biological prosthesis combined with PRP could effectively reduce the level of serum procollagen type I carboxy terminal peptide (PICP) and better improve the levels of bone alkaline phosphatase (BALP) and bone Gla protein (BGP), so as to reduce the bone conversion rate and promote the formation of new bone around the prosthesis. In addition, no significant difference was found in intraoperative bleeding, operation time, hospital stay, 48 h drainage volume, partial weight-bearing time, and complete weight-bearing time between two groups. Otherwise, the use of biological prosthesis could effectively avoid the occurrence of adverse reactions such as bone cement crisis and fracture around femoral prosthesis, so as to better restore the hip function and improve patients' life quality.

Conclusions

Therefore, in hemi hip replacement of FNF in the elderly, nHA biological prosthesis combined with PRP can effectively promote the formation of new bone around the prosthesis stem, so as to obtain good initial stability, enable patients to carry out early weight-bearing exercise, and effectively avoid adverse reactions caused by bone cement prosthesis, thus improving patients' hip function and life quality.

Cemented and uncemented hemiarthroplasty for femoral neck fracture in elderly patients: a systematic review and meta-analysis

BACKGROUND

Cemented hemiarthroplasty to treat femoral neck fractures (FNFs) in elderly patients is controversial. Therefore, this study aimed to compare cemented vs uncemented outcomes.

METHODS

A literature review using Pubmed, EMBASE, Cochrane Library, and Science Citation Index databases was conducted. Studies comparing outcomes of cemented with uncemented hemiarthroplasty for FNFs in elderly patients up to March 2020 were included. Dichotomous outcomes were pooled and reported as relative risk (RR) or odds ratio (ORs), while continuous outcomes were pooled and reported as the mean difference (MD) or standardized mean difference (SMD).

RESULTS

The analysis included 39 studies with a total of 112 576 patients. Pooled analysis revealed that compared with cemented, patients with uncemented intervention had better outcomes for intraoperative blood loss (OR 0.19; 95% CI 0.01-0.37), systolic blood pressure (OR 2.83; 95% CI 1.51-5.28), surgery duration (SMD, 0.51; 95% CI 0.2-0.81), length of anesthesia (OR 0.28; 95% CI 0.11-0.45), 6-month mortality (OR 1.11; 95% CI 1.03-1.2), cardiovascular accidents (OR 2.14; 95% CI 1.07-4.28), respiratory failure (OR 8.26; 95% CI 1.38-49.4), fat embolisms (OR 1.58; 95% CI 1.29-1.93), and heterotrophic ossification (OR 2.3; 95% CI 1.3-4.06), but more intraoperative accidents (OR 0.34; 95% CI 0.26-0.45), postoperative fractures (OR 0.27; 95% CI 0.21-0.34), reoperations (OR 0.59; 95% CI 0.53-0.65), and revisions (OR 0.62; 95% CI 0.44-0.88).

CONCLUSIONS

Meta-analysis of hemiarthroplasty outcomes shows that elderly patients who underwent uncemented vs cemented procedures had better results for several factors that are important for not only improved recovery in elderly populations, but also more intraoperative and postoperative risks.

The Effect of Type of Femoral Component Fixation on Mortality and Morbidity after Hip Hemiarthroplasty: A Systematic Review and Meta-Analysis

BACKGROUND

Hip hemiarthroplasty is a well-established treatment of displaced femoral neck fracture, although debate exists over whether cemented or uncemented fixation is superior. Uncemented prostheses have typically been used in younger, healthier patients and cemented prostheses in older patients with less-stable bone. Also, earlier research has suggested that bone cement has cytotoxic effects and may trigger cardiovascular and respiratory adverse events.

QUESTIONS/PURPOSES

The aim of this systematic review and meta-analysis was to compare morbidity and mortality rates after cemented and uncemented hemiarthroplasty for the treatment of displaced femoral neck fractures in elderly patients.

METHODS

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched seven medical databases for randomized clinical trials and observational studies. We compared cemented and uncemented hemiarthroplasty using the Harris Hip Score (HHS), as well as measures of postoperative pain, mortality, and complications. Data were extracted and pooled as risk ratios or standardized mean difference with their corresponding 95% confidence intervals in a meta-analysis model.

RESULTS

The meta-analysis included 34 studies (12 randomized trials and 22 observational studies), with a total of 42,411 patients. In the pooled estimate, cemented hemiarthroplasty was associated with less risk of postoperative pain than uncemented hemiarthroplasty. There were no significant differences between groups regarding HHS or rates of postoperative mortality, pulmonary embolism, cardiac arrest, myocardial infarction, acute cardiac arrhythmia, or deep venous thrombosis.

CONCLUSIONS

While we found that cemented hemiarthroplasty results in less postoperative pain than uncemented hemiarthroplasty in older patients with femoral neck fracture, the lack of significant differences in functional hip scores, mortality, and complications was surprising. Further high-level research is needed.

Comparative Study of Surgical Management of Fracture Neck of Femur with Cemented Versus Uncemented Bipolar Hemiarthroplasty

INTRODUCTION

There is evidence for use of cemented hemiarthroplasty resulting in greater anchoring and lesser peri prosthetic fracture. However, this procedure results in more haemodynamic instability and cardiopulmonary complications termed as 'cement reaction' or bone cement implantation syndrome. There has been a heightened interest among surgeons to compare cemented and uncemented hemiarthroplasty for fracture neck of femur.

AIM

To compare cemented and uncemented hemiarthroplasty in terms of blood loss during the procedure, post-operative complications, mortality, functional recovery and long term clinical outcome.

MATERIALS AND METHODS

In a prospective study spanning 8 years from January 2006 to January 2014 in a tertiary care hospital, 52 cases of fracture of neck were selected. Twenty four patients underwent cemented and 28 patients underwent uncemented hemiarthroplasty. Mean follow up duration was 59.3 months. Harris Hip Score evaluation was done at each follow up. Radiological evaluation was done at each follow up for calcar length and periprosthetic fractures.

RESULTS

Mean age of patients was 70 years. Harris Hip scores at 3, 6 and 12 months did not show statistically significant differences. Periprosthetic osteolysis or loosening was not seen in the present study. No complications noted in uncemented hemiarthroplasty. Four patients who had cemented hemiarthroplasty had infections. No mortality occurred during admission and within 12 months after surgery.

CONCLUSION

No significant difference was noted between the cemented and uncemented hemiarthroplasty procedures on long term follow up in terms of functionality. No re-operations and no mortality reported. Cemented hemiarthroplasty had more blood loss and minimal post-operative complications.