Mortality associated with cemented and uncemented fixation of hemiarthroplasty and total hip replacement in the surgical management of intracapsular hip fractures: A systematic review and meta-analysis

Elizabeth D Dominguez, Nakulan N Kumar, Michael R Whitehouse, Adrian Sayers

Research output: Contribution to journalArticle (Academic Journal)peer-review

3 Citations (Scopus)

Abstract

BACKGROUND: The use of bone cement for implant fixation in the surgical management of intracapsular hip fractures (IHFs) remains controversial. Although UK national guidance supports cementation, many surgeons remain cautious of its use. In this systematic review and meta-analysis, we aimed to evaluate evidence surrounding post-operative mortality associated with cemented and uncemented total hip replacement and hemiarthroplasty implants.

METHODS: We conducted a search of MEDLINE and Embase databases for randomised controlled trials (RCTs) from commencement until 17 June 2020. Articles reporting mortality or patient survival as an outcome following total hip replacement (THR) or hemiarthroplasty (HA) to manage IHFs were included. Articles not comparing cemented and uncemented fixation were excluded. A meta-analysis on mortality stratified by post-operative follow-up period was conducted using a fixed-effects model. The Revised Cochrane risk-of-bias tool for randomized trials was used to assess risk of bias.

RESULTS: Our initial search found 77 references, 13 of which were eligible for full-text review. Mortality data from 12 studies were pooled and included in the meta-analysis. 1 599 operations were reported: 882 involved cemented fixation; 717, uncemented. Mortality outcome reporting ranged from less than 7 days to 5 years post-operation. No significant difference was observed between the two groups in mortality at any follow-up period. Study quality assessment revealed low certainty in mortality estimates.

CONCLUSION: Existing evidence indicates that cementation has no effect on mortality at any reported follow-up time period. Even with the use of evidence synthesis, the sample size remains relatively low for mortality outcomes and insufficiently powered to reliably determine differences between groups.

Original languageEnglish
Pages (from-to)2605-2616
Number of pages12
JournalInjury
Volume53
Issue number7
DOIs
Publication statusPublished - Jul 2022

Bibliographical note

Funding Information:
This study was supported by the NIHR Biomedical Research Centre at the University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. AS was supported by an MRC strategic skills fellowship (MR/L01226X/1).

Funding Information:
This study was supported by the NIHR Biomedical Research Centre at the University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. AS was supported by an MRC strategic skills fellowship (MR/L01226X/1).

Publisher Copyright:
© 2022 Elsevier Ltd

Keywords

  • Arthroplasty, Replacement, Hip
  • Bone Cements
  • Cementation
  • Femoral Neck Fractures/surgery
  • Hemiarthroplasty
  • Hip Fractures/surgery
  • Hip Prosthesis
  • Humans
  • Treatment Outcome

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