Higher rate of complications with uncemented compared to cemented total hip arthroplasty for displaced intracapsular hip

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ORIGINAL ARTICLE

Higher rate of complications with uncemented compared to cemented total hip arthroplasty for displaced intracapsular hip fractures: A randomised controlled trial of 50 patients N. D. Clement1   · Marietta van der Linden2 · J. F. Keating1 Received: 29 September 2020 / Accepted: 3 October 2020 © The Author(s) 2020

Abstract Background  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 secondary aims were to assess length of surgery, blood loss, complications and revision rate between the two groups. Methods  A 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. Results  The 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). Conclusion  There 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. Keywords  Total hip arthroplasty · Cemented · Uncement · Outcome · Function

Introduction * N. D. Clement [email protected] Marietta van der Linden [email protected] J. F. Keating [email protected] 1



Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Little France, Edinburgh EH16 4SA, UK



Centre for Health Activity and Rehabilitation Research, Queen Margaret University, Edinburgh EH21 6UU, UK

2

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-operat