Abstract
BackgroundThe primary aim of this study was to compare the functional outcome of uncemented with cemented total hip arthroplasty (THA) for displaced intracapsular hip fractures. The secondary aims were to assess length of surgery, blood loss, complications and revision rate between the two groups.MethodsA prospective double-blind randomised control trial was conducted. Fifty patients with an intracapsular hip fracture meeting the inclusion criteria were randomised to either an uncemented (n = 25) or cemented (n = 25) THA. There were no differences (p > 0.45) in age, gender, health status or preinjury hip function between the groups. The Oxford hip score (OHS), Harris Hip score (HHS), EuroQol 5-dimensional (EQ5D), timed get up-and-go (TUG), pain and patient satisfaction were used to assess outcome. These were assessed at 4, 12 and 72 months after surgery, apart from the TUG which as only assessed as 6 months.ResultsThe study was terminated early due to the significantly (n = 8, p = 0.004) higher rate of intraoperative complications in the uncemented group: three fractures of the proximal femur and five conversions to a cemented acetabular component. There were no significant (p ≥ 0.09) differences in the functional measures (OHS, HSS, EQ5D, TUG and pain) or patient satisfaction between the groups. There was no difference in operative time (p = 0.75) or blood loss (p = 0.66) between the groups. There were two early revisions prior to 3 months post-operatively in the uncemented group and none in the cemented group, but this was not significant (log rank p = 0.16).ConclusionThere was a high rate of intraoperative complications, which may be due to poor bone quality in this patient group. There were no ergonomic or functional advantages demonstrated between uncemented and cemented THA. Cemented THA should remain as the preferred choice for the treatment of intracapsular hip fractures for patients that meet the criteria for this procedure.
Highlights
Total hip arthroplasty (THA) is an accepted management option for displaced intracapsular neck of femur fractures for independent elderly patients [1]
Gavaskar et al [8] found uncemented total hip arthroplasty (THA) to be associated with a shorter operative time, lower blood loss and shorter length of stay when compared to cemented THA, this was a non-randomised comparative study consisting of only 31 patients in each group
There were no significant differences in gender, age, body mass index (BMI), ASA grade or hip specific preoperative function between the cemented and uncemented groups (Table 1)
Summary
Total hip arthroplasty (THA) is an accepted management option for displaced intracapsular neck of femur fractures for independent elderly patients [1]. THA relative to a hemiarthroplasty for the treatment of displaced intracapsular neck of femur fractures offers the potential of a better post-operative hip specific functional outcome and overall generic health but is associated with a higher rate of dislocation and a longer operative time [2, 3]. Gavaskar et al [8] found uncemented THA to be associated with a shorter operative time, lower blood loss and shorter length of stay when compared to cemented THA, this was a non-randomised comparative study consisting of only 31 patients in each group. The primary aim of this study was to compare the functional outcome of uncemented with cemented total hip arthroplasty (THA) for displaced intracapsular hip fractures. The Oxford hip score (OHS), Harris Hip score (HHS), EuroQol 5-dimensional (EQ5D), timed get up-and-go (TUG), pain and patient satisfaction were used to assess outcome. Cemented THA should remain as the preferred choice for the treatment of intracapsular hip fractures for patients that meet the criteria for this procedure
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