Cemented or cementless THA in patients over 80 years with fracture neck of femur: a prospective comparative trial

Abstract

Total hip arthroplasty is associated with a better long term outcome and lesser reoperation rates in the elderly but the risk of complications are believed to be higher in very elderly patients. The study aims to compare the short-term results of cemented and cementless total hip arthroplasty (THA) in active patients >80 years of age with femoral neck fractures. Sixty-two consecutive patients underwent THA during the study period (cemented--31 and cementless--31). The mean age was 84 years (81-94 years). Patients in both groups were comparable in their preoperative variables. Functional and radiological assessments were carried out using validated outcome measures. Complications were recorded. Fifty-one patients were available for final analysis after accounting for deaths and cases lost in follow-up. Of the 51 patients, 25 (49%) regained their pre-injury mobility status and 36 (70%) were community ambulant. Cementless THA was associated with significantly less surgical time, blood loss, transfusion rates and hospital stay. The overall mortality rates, complications, functional and radiological results were similar in both groups though the number of deaths in the perioperative period was significantly high in patients undergoing cemented THA. Satisfactory improvement in function with low reoperation rates can be achieved irrespective of the technique used. Complication rates are higher when compared to younger patients undergoing the procedure. Risks and benefits should be carefully assessed and explained before subjecting these patients to THA.