The effect of type of femoral component fixation on mortality and morbidity after hip hemiarthroplasty:A systematic review and meta-analysis

Background: Hip hemiarthroplasty is a well-established treatment of displaced femoral neck fracture, although debate exists over whether cemented or uncemented fixation is superior. Uncemented prostheses have typically been used in younger, healthier patients and cemented prostheses in older patients with less-stable bone. Also, earlier research has suggested that bone cement has cytotoxic effects and may trigger cardiovascular and respiratory adverse events. Questions/Purposes: The aim of this systematic review and meta-analysis was to compare morbidity and mortality rates after cemented and uncemented hemiarthroplasty for the treatment of displaced femoral neck fractures in elderly patients. Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched seven medical databases for randomized clinical trials and observational studies. We compared cemented and uncemented hemiarthroplasty using the Harris Hip Score (HHS), as well as measures of postoperative pain, mortality, and complications. Data were extracted and pooled as risk ratios or standardized mean difference with their corresponding 95% confidence intervals in a meta-analysis model. Results: The meta-analysis included 34 studies (12 randomized trials and 22 observational studies), with a total of 42,411 patients. In the pooled estimate, cemented hemiarthroplasty was associated with less risk of postoperative pain than uncemented hemiarthroplasty. There were no significant differences between groups regarding HHS or rates of postoperative mortality, pulmonary embolism, cardiac arrest, myocardial infarction, acute cardiac arrhythmia, or deep venous thrombosis. Conclusions: While we found that cemented hemiarthroplasty results in less postoperative pain than uncemented hemiarthroplasty in older patients with femoral neck fracture, the lack of significant differences in functional hip scores, mortality, and complications was surprising. Further high-level research is needed

Hemiarthroplasty: To cement or not to cement? A preliminary report

Two hundred hemiarthroplasties were studied to compare uncemented Austin Moore and cemented Thompson's prostheses. The following variables were compared: preoperative mobility, ASA grade, Abbreviated Mental test scores, surgeon grade, peri-operative mortality, infection rate, operation time, intra-operative fractures, dislocation rate, thigh pain and revision rate to total hip replacement. Both groups were comparable in all respects. The incidence of intra-operative fractures, infection, postoperative dislocation and conversion to Girdlestone arthroplasty was higher in the uncemented group. The mortality remained the same in both groups. The incidence of significant thigh pain was higher in the uncemented group (13%), of whom half (6%) had to undergo a conversion to a total hip replacement within the 24 months follow-up period. Our current study of changed practice concluded that cemented Thompson's prosthesis performs better than uncemented Austin Moore when the incidence of hip pain and subsequent conversion to a total hip replacement were considered. © Wichtig Editore, 2004

Unrecognised post-operative hyponatraemia in the elderly with hip fractures

Inappropriate fluid therapy and surgical stress further decrease renal ability to excrete water. This results in hyponatraemia in the elderly, who tend to have a precarious homeostatic equilibrium. There is a high incidence of post-perative hyponatraemia in elderly patients undergoing surgery. We scrutinised biochemistry records, notes and fluid charts in 227 patients who had undergone treatment for hip fractures. Patients with a possible medical cuase for hyponatraemia (25) were excluded. The group of 202 patients had an average age of 77.8 years. We noted an incidence of 17.8% of mild hyponatraemia and 4.4% of severe hyponatraemia. A high index of clinical suspicion and sound knowledge of fluid balance can prevent this potentially serious complication