Abstract
Background: Femoral neck fractures account for over 90% of hip fractures, occurring in roughly identical proportions with high morbidity and mortality in the elderly population. Hemiarthroplasty contributes to early ambulation and good functional recovery. Femoral neck fractures treated via cemented hemiarthroplasty may be less prone to periprosthetic fracture and prosthetic loosening whereas some cases of uncemented implants yield the same clinical results as cemented implants when used to treat displaced femoral neck fractures. To this purpose we evaluated surgical outcome of bipolar hemiarthroplasty in displaced femoral neck fracture using a cemented versus cementless prosthesis.
Methods:
This prospective study was conducted at a single tertiary care center between January 2005 and December 2009. All the patients included in this study were ambulatory prior to the fracture. End points noted in this study includes Proportion of participants developing complications, operative time, postoperative pain, duration of hospital stay and time taken to resume normal work was also evaluated. Postoperative pain was assessed using visual analogue scale (VAS) at 24 hours and 48 hours post-operatively. Descriptive statistical analysis has been carried out in the present study. SPSS 15.0 Statistical software was used for the analysis of the data and Microsoft word and Excel have been used to generate tables etc. Results on continuous measurements were presented as Mean ± SD and categorical data as actual numbers and percentages. Unpaired t test, ANOVA and Chi-square test were used to test significance between two groups. P value is considered to be significant when it is less than 0.05 (P < 0.05).
Results:
A total of 44 patients underwent bipolar hemi-arthroplasty for displaced femoral neck fracture. 24 had cemented and remaining 20 received cementless prosthesis. The cemented and cementless groups did not differ significantly in terms of patient age, gender, number of major co-morbidities, and pre-fracture ambulatory status. The cemented group had significantly longer operating time (95±18 vs. 81±18 minutes, p=0.017, t test) and greater intra-operative blood loss (371±154 vs. 290±147 ml, p=0.024, t test) than the cementless group, but the difference was not significant in terms of the need for blood transfusion and postoperative blood loss (closed suction drains). The length of hospital stay, functional outcome in terms of post-operative ambulatory status, and post-operative complications were similar in both groups. The one-year mortality was similar between the cemented and cementless groups (11/96 [11.5%] vs. 13/111 [11.7%]). After a mean follow-up period of 2.4 (range, 2–4.2) years, 75 patients in the cemented and 89 patients in the cementless groups were available for review. Postoperative thigh pain was significantly higher in the cementless group (p=0.023).
Conclusion:
Cementless hemiarthroplasty is preferred over cemented hemiarthroplasty because of reduced operating time and intra-operative blood loss. It was associated with increased postoperative thigh pain, but functional outcomes, complications, and mortality were similar between the 2 groups.