Hip fractures in elderly patients treated with bipolar hemiarthroplasty: comparison between cemented and cementless implants

Abstract A prospective, randomised study was conducted to evaluate the clinical and functional outcomes at 12 months of followup in two groups of patients affected by femoral neck fractures and treated with cemented or cementless bipolar hemiarthroplasty. Fifty-three cemented and 53 cementless prostheses were implanted on alternate days in 106 consecutive patients. We considered general demographic variables (age, sex, side of injury), operative delay, number of pre-existing conditions, ASA score, haemoglobin levels at admission and pre- and postoperatively, number of blood units transfused perioperatively, duration of operation, clinical complications, hospital stay and mortality within one year after discharge. At follow-up, a Total Functional Score (from 0 to 18 points) was used to evaluate walking ability and personal and daily activity. Furthermore, the economic costs of hospital care (medical and nursing staff, drugs, diagnostic procedures, blood transfusions, hospital stay) and prostheses in the 2 groups of patients were considered. There was no significant difference between the 2 groups of patients regarding most variables, except for postoperative haemoglobin value (9.60±1.88 g/dl in cemented group vs 8.80±8.70 g/dl in cementless group, p=0.018) and duration of operation (75.00±22.43 min in cemented group and 56.98±55.00 min in cementless group, p<0.001). Furthermore, there was no difference regarding 1-year mortality (24.5% in cemented group and 26.4% in cementless group) or in total functional score (9.13±6.02 in cemented group and 8.95±5.86 in cementless group). Economic evaluation revealed that the cementless implant costs 1980 euro while the cemented one costs 1065 euro. In our study, the morbility rate for elderly patients with femoral neck fracture was higher than in the literature. The mortality rate and functional outcome at 12 months of follow-up were similar in the two groups of patients. Considering the higher cost for the cementless prosthesis, the use of cementless bipolar hemiarthropalsy does not seem to be justified in daily orthopaedic practice for the treatment of femoral neck fractures in elderly patients.