Cemented Versus Noncemented Hemiarthroplasty for Femoral Neck Fractures: A Meta-Analysis of Randomized Control Trials.

INTRODUCTION

The purpose of this study was to conduct a meta-analysis of the randomized controlled trials (RCTs) to compare the outcomes after cemented and noncemented hemiarthroplasty for femoral neck fractures.

METHODS

A literature search of three databases was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RCTs comparing cemented and noncemented hemiarthroplasty for femoral neck fractures were included. Clinical outcomes were compared using Revman, and a P-value < 0.05 was considered to be statistically significant.

RESULTS

Nine RCTs with 3,177 patients were included. Overall, 24.2% of patients treated with a cemented hemiarthroplasty and 28.6% of patients treated with cemented hemiarthroplasty died within 1 year (P = 0.01), but there was no significant difference in perioperative mortality or mortality at 30 days (P > 0.05 for both). A significantly lower rate of periprosthetic fractures with cemented hemiarthroplasty (0.9% versus 4.8%, P < 0.0001) was also noted, but there was no significant difference in the rate of revision surgery, dislocations, or wound infections (P > 0.05). Noncemented hemiarthroplasty resulted in significantly faster surgical times (61.7 versus 69.5 minutes, P = 0.007).

DISCUSSION: The current level 1 evidence shows that cemented hemiarthroplasty for femoral neck fractures offers improved 1-year mortality rates and less periprosthetic fracture compared with noncemented hemiarthroplasty. Despite the increase in surgical time, cemented hemiarthroplasty offers compelling clinical advantages compared with noncemented hemiarthroplasty for surgical management of displaced femoral neck fractures in the elderly.

LEVEL OF EVIDENCE: Level I; meta-analysis of Level I studies.