Thompson hemiarthroplasty of hip: Is cement an essential ingredient?

Abstract

Introduction: Thompson hemiarthroplasty of hip for fractured neck of femur is traditionally done with cement to improve stability of fixation. Thompson prosthesis was designed originally to be used without cement. It has now become a routine practice to cement this prosthesis in most centres. In our department most elderly patients with a fractured neck of femur are treated with an uncemented Thompson prosthesis. Cement is used only if the prosthesis appears unstable at any stage of the operation. Materials & Methods: We audited all thompson hemi-arthroplasties performed over a year with a minimum follow up of a year. Results: In hospital mortality was 9.5% and 1 year mortality was 47.6%. Prosthesis survival at end of first year with revision as end point was 100%. We found acceptable complication rate in these patients; respiratory infection (19%), cardiac failure (6%). The rate of dislocation (1.5%) and deep infection (3%) were low as well. Intra-operatively plan was changed and 5 prostheses were cemented because of obvious loose fit. Conclusions: We conclude that cement is not an essential ingredient in Thompson hemiarthroplasty. Along with the obvious reduction in cost, a low revision rate in contrast to general belief makes it an even more attractive option in these elderly patients.