Skip to main content
Top
Published in: Journal of Orthopaedic Surgery and Research 1/2019

Open Access 01-12-2019 | Periprosthetic Fracture | Research article

Long-term follow-up outcomes for patients undergoing primary total hip arthroplasty with uncemented versus cemented femoral components: a retrospective observational study with a 5-year minimum follow-up

Authors: Tiejian Liu, Xiaoxiao Hua, Weiguang Yu, Jinluan Lin, Mingdong Zhao, Jun Liu, Xianshang Zeng

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2019

Login to get access

Abstract

Background

This retrospective analysis compared the long-term outcomes for patients with a femoral neck fracture (AO/OTA type 31B) treated with a primary unilateral total hip arthroplasty with uncemented or cemented femoral components (UTHA or CTHA, respectively).

Methods

We conducted a retrospective cohort study using the South China Hip Arthroplasty Database. We identified 422 patients with femoral neck fracture (AO/OTA type 31B) who were previously treated with primary unilateral UTHA or CTHA between 2007 and 2015, with follow-up until 2019. Follow-up occurred 1, 3, 6 and 12 months postoperatively and yearly thereafter. The primary outcome was the Harris hip score (HHS). The secondary outcome was the orthopaedic complication rate.

Results

In total, 324 patients (UTHA n = 160, mean age 68.61 ± 7.49 years; CTHA n = 164, mean age 68.75 ± 7.04 years) were evaluated for study eligibility. The median follow-up was 73.3 months (range, 11.6–89.2 months). At the final follow-up, HHS was 74.09 ± 6.23 vs 79.01 ± 10.21 (UTHA vs CTHA, p = 0.012). Significant differences were detected in the incidence of prosthetic revision, loosening, and periprosthetic fracture between the UTHA and CTHA groups (7.5% for UTHA vs 1.8% for CTHA, p = 0.015; 17.5% for UTHA vs 8.5% for CTHA, p = 0.016; 11.9% for UTHA vs 4.9% for CTHA, p = 0.021, respectively).

Conclusion

In this setting, CTHA demonstrated superiority to UTHA by improving functional outcomes and decreasing complication rates.
Literature
1.
go back to reference Baker RP, Squires B, Gargan MF, Bannister GC. Total hip arthroplasty and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck - a randomized, controlled trial. J Bone Joint Surg Am. 2006;88A(12):2583–9.CrossRef Baker RP, Squires B, Gargan MF, Bannister GC. Total hip arthroplasty and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck - a randomized, controlled trial. J Bone Joint Surg Am. 2006;88A(12):2583–9.CrossRef
2.
go back to reference Bhandari M, Devereaux PJ, Tornetta P, Swiontkowski MF, Berry DJ, Haidukewych G, et al. Operative management of displaced femoral neck fractures in elderly patients - an international survey. J Bone Joint Surg Am. 2005;87A(9):2122–30.CrossRef Bhandari M, Devereaux PJ, Tornetta P, Swiontkowski MF, Berry DJ, Haidukewych G, et al. Operative management of displaced femoral neck fractures in elderly patients - an international survey. J Bone Joint Surg Am. 2005;87A(9):2122–30.CrossRef
3.
go back to reference Ju DG, Rajaee SS, Mirocha J, Lin CA, Moon CN. Nationwide analysis of femoral neck fractures in elderly patients a receding tide. J Bone Joint Surg Am. 2017;99(22):1932–40.CrossRef Ju DG, Rajaee SS, Mirocha J, Lin CA, Moon CN. Nationwide analysis of femoral neck fractures in elderly patients a receding tide. J Bone Joint Surg Am. 2017;99(22):1932–40.CrossRef
4.
go back to reference Healy WL, Iorio R. Total hip arthroplasty-optimal treatment for displaced femoral neck fractures in elderly patients. Clin Orthop Relat Res. 2004;429:43–8.CrossRef Healy WL, Iorio R. Total hip arthroplasty-optimal treatment for displaced femoral neck fractures in elderly patients. Clin Orthop Relat Res. 2004;429:43–8.CrossRef
5.
go back to reference Schwartz BE, Piponov HI, Helder CW, Mayers WF, Gonzalez MH. Revision total hip arthroplasty in the United States: national trends and in-hospital outcomes. Int Orthop. 2016;40(9):1793–802.CrossRef Schwartz BE, Piponov HI, Helder CW, Mayers WF, Gonzalez MH. Revision total hip arthroplasty in the United States: national trends and in-hospital outcomes. Int Orthop. 2016;40(9):1793–802.CrossRef
6.
go back to reference DeAngelis JP, Ademi A, Staff I, Lewis CG. Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: a prospective randomized trial with early follow-up. J Orthop Trauma. 2012;26(3):135–40.CrossRef DeAngelis JP, Ademi A, Staff I, Lewis CG. Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: a prospective randomized trial with early follow-up. J Orthop Trauma. 2012;26(3):135–40.CrossRef
7.
go back to reference Schmidt AH, Leighton R, Parvizi J, Sems A, Berry DJ. Optimal arthroplasty for femoral neck fractures: is total hip arthroplasty the answer? J Orthop Trauma. 2009;23(6):428–33.CrossRef Schmidt AH, Leighton R, Parvizi J, Sems A, Berry DJ. Optimal arthroplasty for femoral neck fractures: is total hip arthroplasty the answer? J Orthop Trauma. 2009;23(6):428–33.CrossRef
8.
go back to reference Yli-Kyyny T, Sund R, Heinanen M, Venesmaa P, Kroger H. Cemented or uncemented hemiarthroplasty for the treatment of femoral neck fractures? Acta Orthop. 2014;85(1):49–53.CrossRef Yli-Kyyny T, Sund R, Heinanen M, Venesmaa P, Kroger H. Cemented or uncemented hemiarthroplasty for the treatment of femoral neck fractures? Acta Orthop. 2014;85(1):49–53.CrossRef
9.
go back to reference Khorami M, Arti H, Aghdam AA. Cemented versus uncemented hemiarthroplasty in patients with displaced femoral neck fractures. Pak J Med Sci. 2016;32(1):44–8.PubMedPubMedCentral Khorami M, Arti H, Aghdam AA. Cemented versus uncemented hemiarthroplasty in patients with displaced femoral neck fractures. Pak J Med Sci. 2016;32(1):44–8.PubMedPubMedCentral
10.
go back to reference Chammout G, Muren O, Boden H, Salemyr M, Skoldenberg O. Cemented compared to uncemented femoral stems in total hip replacement for displaced femoral neck fractures in the elderly: study protocol for a single-blinded, randomized controlled trial (CHANCE-trial). BMC Musculoskelet Disord. 2016;17(1):398. Chammout G, Muren O, Boden H, Salemyr M, Skoldenberg O. Cemented compared to uncemented femoral stems in total hip replacement for displaced femoral neck fractures in the elderly: study protocol for a single-blinded, randomized controlled trial (CHANCE-trial). BMC Musculoskelet Disord. 2016;17(1):398.
11.
go back to reference Viberg B, Overgaard S, Lauritsen J, Ovesen O. Lower reoperation rate for cemented hemiarthroplasty than for uncemented hemiarthroplasty and internal fixation following femoral neck fracture 12-to 19-year follow-up of patients aged 75 years or more. Acta Orthop. 2013;84(3):254–9.CrossRef Viberg B, Overgaard S, Lauritsen J, Ovesen O. Lower reoperation rate for cemented hemiarthroplasty than for uncemented hemiarthroplasty and internal fixation following femoral neck fracture 12-to 19-year follow-up of patients aged 75 years or more. Acta Orthop. 2013;84(3):254–9.CrossRef
12.
go back to reference Chammout G, Muren O, Laurencikas E, Boden H, Kelly-Pettersson P, Sjoo H, et al. More complications with uncemented than cemented femoral stems in total hip replacement for displaced femoral neck fractures in the elderly. A single-blinded, randomized controlled trial with 69 patients. Acta Orthop. 2017;88(2):145–51.CrossRef Chammout G, Muren O, Laurencikas E, Boden H, Kelly-Pettersson P, Sjoo H, et al. More complications with uncemented than cemented femoral stems in total hip replacement for displaced femoral neck fractures in the elderly. A single-blinded, randomized controlled trial with 69 patients. Acta Orthop. 2017;88(2):145–51.CrossRef
13.
go back to reference Laupacis A, Bourne R, Rorabeck C, Feeny D, Tugwell P, Wong C. Comparison of total hip arthroplasty performed with and without cement—a randomized trial. J Bone Joint Surg Am. 2002;84A(10):1823–8.CrossRef Laupacis A, Bourne R, Rorabeck C, Feeny D, Tugwell P, Wong C. Comparison of total hip arthroplasty performed with and without cement—a randomized trial. J Bone Joint Surg Am. 2002;84A(10):1823–8.CrossRef
14.
go back to reference Langslet E, Frihagen F, Opland V, Madsen JE, Nordsletten L, Figved W. Cemented versus Uncemented Hemiarthroplasty for displaced femoral neck fractures: 5-year Followup of a randomized trial. Clin Orthop Relat Res. 2014;472(4):1291–9.CrossRef Langslet E, Frihagen F, Opland V, Madsen JE, Nordsletten L, Figved W. Cemented versus Uncemented Hemiarthroplasty for displaced femoral neck fractures: 5-year Followup of a randomized trial. Clin Orthop Relat Res. 2014;472(4):1291–9.CrossRef
15.
go back to reference Ochi H, Baba T, Homma Y, Matsumoto M, Watari T, Ozaki Y, et al. Total hip arthroplasty via the direct anterior approach with a dual mobility cup for displaced femoral neck fracture in patients with a high risk of dislocation. SICOT J. 2017;3:56.CrossRef Ochi H, Baba T, Homma Y, Matsumoto M, Watari T, Ozaki Y, et al. Total hip arthroplasty via the direct anterior approach with a dual mobility cup for displaced femoral neck fracture in patients with a high risk of dislocation. SICOT J. 2017;3:56.CrossRef
16.
go back to reference Makela KT, Matilainen M, Pulkkinen P, Fenstad AM, Havelin L, Engesaeter L, et al. Failure rate of cemented and uncemented total hip replacements: register study of combined Nordic database of four nations. BMJ. 2014;348:f7592.CrossRef Makela KT, Matilainen M, Pulkkinen P, Fenstad AM, Havelin L, Engesaeter L, et al. Failure rate of cemented and uncemented total hip replacements: register study of combined Nordic database of four nations. BMJ. 2014;348:f7592.CrossRef
17.
go back to reference Wang F, Zhang HF, Zhang ZY, Ma CB, Feng XM. Comparison of bipolar hemiarthroplasty and total hip arthroplasty for displaced femoral neck fractures in the healthy elderly: a meta-analysis. BMC Musculoskelet Disord. 2015;16(1):1–13. Wang F, Zhang HF, Zhang ZY, Ma CB, Feng XM. Comparison of bipolar hemiarthroplasty and total hip arthroplasty for displaced femoral neck fractures in the healthy elderly: a meta-analysis. BMC Musculoskelet Disord. 2015;16(1):1–13.
18.
go back to reference Achten J, Parsons NR, Edlin RP, Griffin DR, Costa ML. A randomised controlled trial of total hip arthroplasty versus resurfacing arthroplasty in the treatment of young patients with arthritis of the hip joint. BMC Musculoskelet Disord. 2010;11:8. Achten J, Parsons NR, Edlin RP, Griffin DR, Costa ML. A randomised controlled trial of total hip arthroplasty versus resurfacing arthroplasty in the treatment of young patients with arthritis of the hip joint. BMC Musculoskelet Disord. 2010;11:8.
19.
go back to reference Dao E, Hsiung GYR, Sossi V, Jacova C, Tam R, Dinelle K, et al. Exploring the effects of coexisting amyloid in subcortical vascular cognitive impairment. BMC Neurol. 2015;15:197. Dao E, Hsiung GYR, Sossi V, Jacova C, Tam R, Dinelle K, et al. Exploring the effects of coexisting amyloid in subcortical vascular cognitive impairment. BMC Neurol. 2015;15:197.
20.
go back to reference Zeng X, Zhan K, Zhang L, Zeng D, Yu W, Zhang X, et al. Conversion to total hip arthroplasty after failed proximal femoral nail antirotations or dynamic hip screw fixations for stable intertrochanteric femur fractures: a retrospective study with a minimum follow-up of 3 years. BMC Musculoskelet Disord. 2017;18(1):38. Zeng X, Zhan K, Zhang L, Zeng D, Yu W, Zhang X, et al. Conversion to total hip arthroplasty after failed proximal femoral nail antirotations or dynamic hip screw fixations for stable intertrochanteric femur fractures: a retrospective study with a minimum follow-up of 3 years. BMC Musculoskelet Disord. 2017;18(1):38.
21.
go back to reference Saudan M, Saudan P, Perneger T, Riand N, Keller A, Hoffmeyer P. Celecoxib versus ibuprofen in the prevention of heterotopic ossification following total hip replacement - a prospective randomised trial. J Bone Joint Surg Br. 2007;89B(2):155–9.CrossRef Saudan M, Saudan P, Perneger T, Riand N, Keller A, Hoffmeyer P. Celecoxib versus ibuprofen in the prevention of heterotopic ossification following total hip replacement - a prospective randomised trial. J Bone Joint Surg Br. 2007;89B(2):155–9.CrossRef
22.
go back to reference Song JSA, Dillman D, Wilson D, Dunbar M, Richardson G. Higher periprosthetic fracture rate associated with use of modern uncemented stems compared to cemented stems in femoral neck fractures. Hip Int. 2019;29(2):177–83.CrossRef Song JSA, Dillman D, Wilson D, Dunbar M, Richardson G. Higher periprosthetic fracture rate associated with use of modern uncemented stems compared to cemented stems in femoral neck fractures. Hip Int. 2019;29(2):177–83.CrossRef
23.
go back to reference Eschen J, Kring S, Brix M, Ban I, Troelsen A. Outcome of an uncemented hydroxyapatite coated hemiarthroplasty for displaced femoral neck fractures: a clinical and radiographic 2-year follow-up study. Hip Int. 2012;22(5):574–9.CrossRef Eschen J, Kring S, Brix M, Ban I, Troelsen A. Outcome of an uncemented hydroxyapatite coated hemiarthroplasty for displaced femoral neck fractures: a clinical and radiographic 2-year follow-up study. Hip Int. 2012;22(5):574–9.CrossRef
24.
go back to reference Hansen SK, Brix M, Birkelund L, Troelsen A. Can introduction of an uncemented, hydroxyapatite coated hemiarthroplasty for displaced femoral neck fractures be recommended? Hip Int. 2010;20(1):109–14.CrossRef Hansen SK, Brix M, Birkelund L, Troelsen A. Can introduction of an uncemented, hydroxyapatite coated hemiarthroplasty for displaced femoral neck fractures be recommended? Hip Int. 2010;20(1):109–14.CrossRef
25.
go back to reference Inngul C, Blomfeldt R, Ponzer S, Enocson A. Cemented versus uncemented arthroplasty in patients with a displaced fracture of the femoral neck a RANDOMISED CONTROLLED TRIAL. Bone Joint J. 2015;97B(11):1475–80.CrossRef Inngul C, Blomfeldt R, Ponzer S, Enocson A. Cemented versus uncemented arthroplasty in patients with a displaced fracture of the femoral neck a RANDOMISED CONTROLLED TRIAL. Bone Joint J. 2015;97B(11):1475–80.CrossRef
26.
go back to reference Imam MA, Shehata MSA, Elsehili A, Morsi M, Martin A, Shawqi M, et al. 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;43(7):1715–23.CrossRef Imam MA, Shehata MSA, Elsehili A, Morsi M, Martin A, Shawqi M, et al. 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;43(7):1715–23.CrossRef
27.
go back to reference Kunutsor SK, Beswick AD, Whitehouse MR, Blom AW, Lenguerrand E. Implant fixation and risk of prosthetic joint infection following primary total hip replacement: meta-analysis of observational cohort and randomised intervention studies. J Clin Med. 2019;8(5):722.CrossRef Kunutsor SK, Beswick AD, Whitehouse MR, Blom AW, Lenguerrand E. Implant fixation and risk of prosthetic joint infection following primary total hip replacement: meta-analysis of observational cohort and randomised intervention studies. J Clin Med. 2019;8(5):722.CrossRef
28.
go back to reference Palan J, Smith MC, Gregg P, Mellon S, Kulkarni A, Tucker K, et al. The influence of cemented femoral stem choice on the incidence of revision for periprosthetic fracture after primary total hip arthroplasty. Bone Joint J. 2016;98B(10):1347–54.CrossRef Palan J, Smith MC, Gregg P, Mellon S, Kulkarni A, Tucker K, et al. The influence of cemented femoral stem choice on the incidence of revision for periprosthetic fracture after primary total hip arthroplasty. Bone Joint J. 2016;98B(10):1347–54.CrossRef
29.
go back to reference Bozic KJ, Ong K, Lau E, Kurtz SM, Vail TP, Rubash HE, et al. Risk of complication and revision Total hip Arthroplasty among Medicare patients with different bearing surfaces. Clin Orthop Relat Res. 2010;468(9):2357–62.CrossRef Bozic KJ, Ong K, Lau E, Kurtz SM, Vail TP, Rubash HE, et al. Risk of complication and revision Total hip Arthroplasty among Medicare patients with different bearing surfaces. Clin Orthop Relat Res. 2010;468(9):2357–62.CrossRef
30.
go back to reference Ahmad R, Sharma V, Sandhu H, Bishay M. Leg length discrepancy in total hip arthroplasty with the use of cemented and uncemented femoral stems. A prospective radiological study. Hip Int. 2009;19(3):264–7.CrossRef Ahmad R, Sharma V, Sandhu H, Bishay M. Leg length discrepancy in total hip arthroplasty with the use of cemented and uncemented femoral stems. A prospective radiological study. Hip Int. 2009;19(3):264–7.CrossRef
31.
go back to reference Flivik G, Kristiansson I, Ryd L. Positive effect of removal of subchondral bone plate for cemented acetabular component fixation in total hip arthroplasty. A randomised rsa study with ten-year follow-up. Bone Joint J. 2015;97B(1):35–44.CrossRef Flivik G, Kristiansson I, Ryd L. Positive effect of removal of subchondral bone plate for cemented acetabular component fixation in total hip arthroplasty. A randomised rsa study with ten-year follow-up. Bone Joint J. 2015;97B(1):35–44.CrossRef
32.
go back to reference Scott CEH, MacDonald D, Moran M, White TO, Patton JT, Keating JF. Cemented total hip arthroplasty following acetabular fracture. Bone Joint J. 2017;99B(10):1399–408.CrossRef Scott CEH, MacDonald D, Moran M, White TO, Patton JT, Keating JF. Cemented total hip arthroplasty following acetabular fracture. Bone Joint J. 2017;99B(10):1399–408.CrossRef
33.
go back to reference Hernandez NM, Chalmers BP, Perry KI, Berry DJ, Yuan BJ, Abdel MP. Total hip Arthroplasty after in situ fixation of minimally displaced femoral neck fractures in elderly patients. J Arthroplast. 2018;33(1):144–8.CrossRef Hernandez NM, Chalmers BP, Perry KI, Berry DJ, Yuan BJ, Abdel MP. Total hip Arthroplasty after in situ fixation of minimally displaced femoral neck fractures in elderly patients. J Arthroplast. 2018;33(1):144–8.CrossRef
34.
go back to reference Medda S, Snoap T, Carroll EA. Treatment of young femoral neck fractures. J Orthop Trauma. 2019;33:S1–6.CrossRef Medda S, Snoap T, Carroll EA. Treatment of young femoral neck fractures. J Orthop Trauma. 2019;33:S1–6.CrossRef
35.
go back to reference Steele CE, Cochran G, Renninger C, Deafenbaugh B, Kuhn KM. Femoral neck stress fractures: MRI risk factors for progression. J Bone Joint Surg Am. 2018;100(17):1496–502.CrossRef Steele CE, Cochran G, Renninger C, Deafenbaugh B, Kuhn KM. Femoral neck stress fractures: MRI risk factors for progression. J Bone Joint Surg Am. 2018;100(17):1496–502.CrossRef
36.
go back to reference Duffin M, Pilson HT. Technologies for young femoral neck fracture fixation. J Orthop Trauma. 2019;33:S20–S6.CrossRef Duffin M, Pilson HT. Technologies for young femoral neck fracture fixation. J Orthop Trauma. 2019;33:S20–S6.CrossRef
Metadata
Title
Long-term follow-up outcomes for patients undergoing primary total hip arthroplasty with uncemented versus cemented femoral components: a retrospective observational study with a 5-year minimum follow-up
Authors
Tiejian Liu
Xiaoxiao Hua
Weiguang Yu
Jinluan Lin
Mingdong Zhao
Jun Liu
Xianshang Zeng
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Journal of Orthopaedic Surgery and Research / Issue 1/2019
Electronic ISSN: 1749-799X
DOI
https://doi.org/10.1186/s13018-019-1415-3

Other articles of this Issue 1/2019

Journal of Orthopaedic Surgery and Research 1/2019 Go to the issue