Uncemented implants at our unit have a lower mortality rate associated with the immediate 30-day postoperative period than cemented implants at up to one year of follow up. Cemented implants had lower periprosthetic fracture and revision rates. Uncemented Hemiarthroplasty may still be considered safe for high-risk patients with intracapsular neck of femur fracture, reducing their risk of mortality in the first 30 days but exposing patients to higher postoperative rates of periprosthetic fracture, need for revision and blood transfusion. Further high-quality research comparing modern uncemented and cemented femoral components is required.

1. Cemented vs Uncemented Hemiarthroplasty
for Intracapasular Neck of Femur Fractures
A Retrospective Single Centre Cohort Study
A Fell1
, A Sobti1
, O. Brown1
, T. Samuel1
, E. Pererra1
, M. Imam1
1. Rowley Bristow Unit, Ashford and St Peters Foundation Hospital Trust, Chertsey, UK
Background
Hip fractures are an operational and financial burden in the UK, with around 70,000 hips treated at a cost of 2 billion pounds a year. For patients with displaced
intracapsular hip fractures, there is strong evidence supporting cemented femoral prosthesis due to its reduced risk of periprosthetic fracture, reduced cost and
lower revision rates. Benefits of modern uncemented prosthesis include quicker operation time and reduced risk of cement related complications.
Study Design and Methods
● Retrospective comparative cohort study from single trauma unit.
● National Hip Fracture database used to identify patients with intracapsular
neck of femur fractures treated with hemiarthroplasty from 1st of January
2015 to 31st of December 2019.
● Electronic Patient Record, Electronic Surgical records and radiographs
were reviewed for analysis of treatment and outcomes.
● Statistical analysis was performed using Microsoft Excel™ and IBM
SPSS™.
Results
794 intracapsular fractures met the inclusion criteria in 753 patients over the 5 year period. 55.5%(441) were treated with uncemented Hemi-Arthroplasty,
44.5%(353) with a cemented Hemiarthroplasty. Demographics, Nottingham Hip Fracture Scores were matched for both cohorts.
Conclusion
Uncemented implants at our unit have a lower mortality rate associated with the immediate 30-day postoperative period than cemented implants at up to one
year of follow up. Cemented implants had lower periprosthetic fracture and revision rates.
Uncemented Hemiarthroplasty may still be considered safe for high-risk patients with intracapsular neck of femur fracture, reducing their risk of mortality in the
first 30 days but exposing patients to higher postoperative rates of periprosthetic fracture, need for revision and blood transfusion. Further high-quality research
comparing modern uncemented and cemented femoral components is required.
Objectives
● Primary outcome: 30 day mortality rate of uncemented
hemiarthroplasty versus cemented hemiarthroplasty
● Secondary outcomes: mortality at 1 year, surgical complications,
reoperation rates in the first 30 days, revision of prosthesis,,
surgical times and pulmonary and cardiac complciations
Uncemented Cemented Total
Total, n 441 (55.5%) 354 (44.5%) 794
Male 133 (30.15%) 102 (28.8%) 235 (29.59%)
Female 308 (69.85%) 251 (71.2%) 559 (70.5%)
Age (Mean years)
(Range) 85.94 (60-103.5) 85.1 (60-103.2)
ASA (Mean) 2.8 3
ASA 1 (total) 8 3
ASA 2 (total) 118 33
ASA 3 (total) 252 246
ASA 4 (total) 63 72
NHFS (Mean) 5.51 5.51
Mean Haemaglobin
on Admission (g/dl) 122.59 122.22
Uncemented Cemented p-value Odds Ratio
30 day
mortality 26 (5.5%)
37
(10.48%) 0.024
1.81 (95% CI, 1.0721 to
3.0649 (p=.026))
1 year
mortality 135 (30.6%)
118
(33.33%) 0.44
1.12 (95% CI, 0.8 to
1.51 (p=0.446))
Reference
1. Imam MA, Shehata MSA, Elsehili A, Morsi M, Martin A, Shawqi M, Grubhofer F, Chirodian N, Narvani A, Ernstbrunner L. Contemporary cemented versus uncemented hemiarthroplasty for the treatment of displaced intracapsular hip fractures: a
meta-analysis of forty-two thousand forty-six hips. Int Orthop. 2019 Jul;43(7):1715-1723. doi: 10.1007/s00264-019-04325-x. Epub 2019 Mar 27. Erratum in: Int Orthop. 2019 May 7;: PMID: 30919045.
2. Parker MJ, Gurusamy KS, Azegami S. Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. Cochrane Database Syst Rev. 2010 Jun 16;(6):CD001706. doi: 10.1002/14651858.CD001706.pub4. PMID:
20556753.
3. Nawaz SZ, Keightley AJ, Desai A, Granville-Chapman J, Elliott D, Newman K, Khaleel A. Displaced intracapsular neck of femur fractures: Outcome of 810 hydroxyapetite coated (HAC) uncemented hemiarthroplasties. Injury. 2017
Apr;48(4):909-913. doi: