Cemented and uncemented hemiarthroplasty for femoral neck fracture in elderly patients: a systematic review and meta-ana
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REVIEW
Cemented and uncemented hemiarthroplasty for femoral neck fracture in elderly patients: a systematic review and meta‑analysis Xinjie Wu1,2 · Yanlei Wang2,3 · Wei Sun1,2 · Mingsheng Tan2 Received: 2 July 2020 / Accepted: 30 September 2020 © Springer Nature Switzerland AG 2020
Abstract Background Cemented hemiarthroplasty to treat femoral neck fractures (FNFs) in elderly patients is controversial. Therefore, this study aimed to compare cemented vs uncemented outcomes. Methods A literature review using Pubmed, EMBASE, Cochrane Library, and Science Citation Index databases was conducted. Studies comparing outcomes of cemented with uncemented hemiarthroplasty for FNFs in elderly patients up to March 2020 were included. Dichotomous outcomes were pooled and reported as relative risk (RR) or odds ratio (ORs), while continuous outcomes were pooled and reported as the mean difference (MD) or standardized mean difference (SMD). Results The analysis included 39 studies with a total of 112 576 patients. Pooled analysis revealed that compared with cemented, patients with uncemented intervention had better outcomes for intraoperative blood loss (OR 0.19; 95% CI 0.01–0.37), systolic blood pressure (OR 2.83; 95% CI 1.51–5.28), surgery duration (SMD, 0.51; 95% CI 0.2–0.81), length of anesthesia (OR 0.28; 95% CI 0.11–0.45), 6-month mortality (OR 1.11; 95% CI 1.03–1.2), cardiovascular accidents (OR 2.14; 95% CI 1.07–4.28), respiratory failure (OR 8.26; 95% CI 1.38–49.4), fat embolisms (OR 1.58; 95% CI 1.29–1.93), and heterotrophic ossification (OR 2.3; 95% CI 1.3–4.06), but more intraoperative accidents (OR 0.34; 95% CI 0.26–0.45), postoperative fractures (OR 0.27; 95% CI 0.21–0.34), reoperations (OR 0.59; 95% CI 0.53–0.65), and revisions (OR 0.62; 95% CI 0.44–0.88). Conclusions Meta-analysis of hemiarthroplasty outcomes shows that elderly patients who underwent uncemented vs cemented procedures had better results for several factors that are important for not only improved recovery in elderly populations, but also more intraoperative and postoperative risks. Keywords Cement · Hemiarthroplasty · Femoral neck fractures
Introduction Femoral neck fractures (FNFs) are serious injuries with high morbidity and mortality in elderly patients. It has been estimated that there were 1,300,000 hip fractures worldwide in 1990 and that the number will increase to between 7,000,000 * Wei Sun [email protected] * Mingsheng Tan [email protected] 1
Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
2
Department of Orthopedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing 100029, China
3
Beijing University of Chinese Medicine, Beijing, China
and 21,000,000 per year by 2050 [1]. In the UK, 66,000 FNFs are treated each year, and over 75% of displaced intracapsular fractures are treated with hemiarthroplasty [2]. It has been reported that about 30% of patients presenting an FNFs die within 1 year of surgery, whereas 25–50% of them face a significant
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