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A RANDOMISED CONTROLLED TRIAL IN 400 PATIENTS
M. I. Parker, G. Pryor, K. Gurusamy
From Peterborough and Stamford Hospital NHS Trust, Peterborough, England
We undertook a prospective randomised controlled trial involving 400 patients with a displaced intracapsular fracture of the hip to determine whether there was any difference in outcome between treatment with a cemented Thompson hemiarthroplasty and an uncemented Austin-Moore prosthesis. The surviving patients were followed up for between two and five years by a nurse blinded to the type of prosthesis used. The mean age of the patients was 83 years (61 to 104) and 308 (77%) were women. The degree of residual pain was less in those treated with a cemented prosthesis (p < 0.0001) three months after surgery. Regaining mobility was better in those treated with a cemented implant (p = 0.005) at six months after operation. No statistically significant difference was found between the two groups with regard to mortality, implant-related complications, re-operations or post-operative medical complications. The use of a cemented Thompson hemiarthroplasty resulted in less pain and less deterioration in mobility than an uncemented Austin-Moore prosthesis with no increase in complications.
M. I. Parker, MD, FRCS(Edin), Orthopaedic Research Fellow G. Pryor, MS, FRCS, Orthopaedic Surgeon Orthopaedic Department Peterborough and Stamford Hospital NHS Foundation Trust, Thorpe Road, Peterborough PE3 6DA, UK. K. Gurusamy, MS, MRCS, Clinical Research Fellow University Department of Surgery Royal Free Hospital, Pond Street, London NW3 2QG, UK. Correspondence should be sent to Dr M. J. Parker; e-mail: Martyn.Parker@pbh-tr.nhs.uk ©2010 British Editorial Society of Bone and Joint Surgery doi:10.1302/0301-620X.92B1. 22753 $2.00 J Bone Joint Surg [Br] 2010;92-B:116-22. Received 27 April 2009; Accepted after revision 27 August 2009
Displaced intracapsular fractures of the neck of the femur are commonly treated by hemiarthroplasty. Orthopaedic surgeons are divided as to the relative merits of cemented versus uncemented prostheses in these patients. Cementing the prosthesis provides more secure fixation and may result in less residual pain and better function. However, the insertion of cement complicates the operation and carries the risk of cardiovascular collapse when the cement is introduced into the femur.1 So far, six small randomised controlled trials involving 549 patients have been summarised in a Cochrane Review on this subject. This reported that patients with cemented prostheses have less pain and a tendency to better mobility than those with uncemented prostheses.1 The authors concluded that there was limited evidence that cementing a prosthesis in place may reduce post-operative pain and lead to better mobility. They highlighted the need for further well-conducted randomised controlled trials. The two most common types of hemiarthroplasty used for the treatment of a displaced intracapsular fracture in the United Kingdom are the uncemented Austin-Moore prosthesis and the cemented Thompson hemiarthroplasty.2 The continued use of a mixture of uncemented and cemented prostheses reflects
uncertainty as to the relative advantages and disadvantages of using bone cement. We therefore undertook a large randomised controlled trial comparing an uncemented Austin-Moore prosthesis with a cemented Thompson hemiarthroplasty in patients with a displaced intracapsular fracture of the proximal femur, with a minimum follow-up of two years’.
Materials and Methods All patients presenting to our institution with a displaced intracapsular fracture of the proximal femur were considered for inclusion in the study. Patients with senile dementia were included with the consent of their next of kin. The inclusion and exclusion criteria are listed in Table I. All patients with an undisplaced or minimally displaced intracapsular fracture were excluded from the study and treated by internal fixation, as were all patients aged less than 60 years with a displaced fracture and those aged between 60 and 75 years in whom there was no impairment of mobility (defined as the ability to walk out of the house unaided) immediately prior to the injury. The study had ethical approval and the support of the hospital research and development committee. Patients were randomised by the opening of a sealed opaque numbered envelope, prepared by a person independent of the
THE JOURNAL OF BONE AND JOINT SURGERY
For those patients who could not be contacted. pain with activities. After randomisation all patients had to stay in the group to which they had been allotted. Subsequent assessments were by telephone at three. All assessments were undertaken by a nurse who was blinded to the treatment undertaken. and thereafter every year for up to five years. No. Survival outcomes . VOL. All patients received peri-operative antibiotic prophylaxis and 14 days of low molecular weight heparin as thromboembolic prophylaxis. six. a narrow-stem implant was used.score 2 Only with someone else’s help . Allowing for deaths and loss to follow-up. The patient’s walking ability immediately prior to the fall was assessed using a mobility scale of 0 to nine. Finally. two occasional and slight pain. and six constant pain with frequent strong analgesia.6. United Kingdom) was inserted after the femur had been prepared by reaming and saline irrigation. Before commencing the study a power calculation was undertaken using the primary outcome of degree of residual pain at one year. stronger analgesia used occasionally. United Kingdom) was generally of the standard size. Statistical analysis. Mobility assessment tool 1. All operations were performed or supervised by one orthopaedic surgeon (MIP) and all by a standard anterolateral approach with repair of the joint capsule. Patients were initially reviewed six weeks after discharge. and also using a scale of one to six in which one was no pain. Newbury. On admission the patient’s mental state was assessed using a ten-point mental test score and their physical state by the American Society of Anaesthesiologists (ASA) score. if the patient could not be contacted.7 where nine represented full mobility indoors and outdoors without walking aids and 0 defined a bedbound patient (Table II).4 Residential status was defined as living in their own home (including warden-controlled accommodation). 1. and all results were analysed on an intention-to-treat basis. United Kingdom) was inserted in a retrograde manner into the femur using a cement gun. The calculation was based on reducing the number of patients with a pain score of ≥ 3 by 10%. nine and 12 months.7 years (2 to 5).3. it was estimated that 200 patients were required in each group. Cirencester. four with no or little pain at rest. At each follow-up assessment the time until 16 activities of daily living were regained was also assessed. Inclusion and exclusion criteria for participants in the study Inclusion criteria Displaced intracapsular fracture in a patient aged over 60 Exclusion criteria Undisplaced or minimally displaced intracapsular fracture Patients aged less than 60 Patients aged 60 to 75 years with no restriction in mobility at the time of injury Patients who declined to participate Patients with senile dementia for whom the assent of their next of kin was not obtained Patients with a pathological fracture from a tumour or Paget’s disease of bone Previous treatment to the same hip for a fracture Patients who were not considered to be fit for either of the surgical procedures Patients with significant arthritis of the hip that necessitated treatment with a total hip replacement Patients admitted when the lead trialist was not available to supervise the surgical procedure study. Binary outcomes for the two groups were analysed using Fisher’s exact test. Could they get about the house? Was the patient able to get out of the house? Could they do their shopping? For each of the three questions: Without any difficulty . They were discharged home as soon as their general condition allowed. Welwyn Garden City. two after four years and one after three years. Three patients were lost to follow-up. For the follow-up assessments.5 The one to six assessment scale was used for telephone follow-up assessments. enquiry was made to the Office of Population Census Service. three pain when starting walking but then getting better with occasional analgesia. The Austin-Moore prosthesis used (Stryker/Howmedica Ltd. with least pain scoring one. but if the femur was slender. frequent mild analgesia. 92-B.score 1 Not at all. regardless of any deviations from the treatment protocol. pain was assessed using a visual analogue scale of one to ten at the outpatient clinic visit. A Hardinge cement restrictor was used and Palacos bone cement with gentamicin (Schering-Plough Ltd. five constant but bearable pain. with no restrictions on hip movements or weight-bearing.score 0 residential care (partial care within an institution) or nursing care (full nursing care or hospital in-patient). All surviving patients had a mean follow-up of 3. 3. 2. The Thompson hemiarthroplasty (Corin Ltd. containing details of the procedure to be undertaken.score 3 On their own with an aid . enquiry was made via their next of kin or their registered medical practitioner. JANUARY 2010 Table II. and continuous outcomes with the Mann-Whitney U test. After surgery all patients were mobilised as soon as they were able.CEMENTED VERSUS UNCEMENTED HEMIARTHROPLASTY FOR INTRACAPSULAR HIP FRACTURES 117 Table I. Bed or chair bound .
Results Patients were recruited over a five-year period. Five patients were considered to be unfit for a cemented hemiarthroplasty immediately prior to or during surgery. A further 11 patients in the uncemented group did not have treatment as defined in the study protocol. but was still treated with a cemented Thompson hemiarthroplasty. K. having previously been considered fit for both procedures.8 A p-value of < 0. until discharge from hospital. THE JOURNAL OF BONE AND JOINT SURGERY . including medical and rehabilitation wards. Four patients were found to have a femur that was too narrow to accommodate a Thompson prosthesis. Operative details. One patient was found at the time of surgery to have a trochanteric fracture and not an intracapsular fracture. Two patients. GURUSAMY 1100 patients admitted with an intracapsular hip fracture between March 2001 and November 2006 Excluded for not meeting inclusion criteria * (700) Undisplaced/minimally displaced (281) Patient too young/fit (104) Pathological fracture (17) No consent (9) Treated conservatively (17) Unfit for hemiarthroplasty (35) Lead trialists not available (268) Other reason (12) Randomised (400) Allocated to cemented hemiarthroplasty (200) Treated as per protocol (189) Had internal fixation (4) Prosthesis not cemented (4) Cemented bipolar hemiarthroplasty used (1) Trochanteric fracture treated (1) Pathological fracture (1) Completed follow-up (74) Died during follow-up period (125) Lost to follow-up (1) Fig. and the prosthesis was therefore cemented in place. Seven were felt to have a prosthesis that was loose at the time of surgery. The characteristics of the two groups of patients are detailed in Table III. PRYOR. The readmissions included were only those for conditions directly related to the hip fracture. Total hospital stay was found to be four days shorter for those treated with a cemented prosthesis. The mean duration of surgery was approximately seven minutes longer for those who had a cemented prosthesis. Three were treated with an uncemented narrow-stem Austin-Moore and one with a cemented bipolar hemiarthroplasty. A further two patients were later found to have a pathological fracture secondary to a tumour. None of the differences between the two groups was statistically significant. PARKER. G. initially considered fit for hemiarthroplasty. The operative details and total hospital stay for the two groups are shown in Table IV. were considered unfit at the time of surgery and treated by reduction and internal fixation. and one further patient was later found to have a pathological fracture from a secondary tumour. and comparison between the groups was performed using the Kaplan-Meier log-rank test. either because of a large femoral cavity or from an operative fracture of the femur. The total hospital stay was the time spent on the orthopaedic and any other wards.* Patients may have been excluded for more than one reason. The reasons for 700 patients not being included in the study are shown in Figure 1. and one had an uncemented Austin-Moore hemiarthroplasty.05 was considered statistically significant. 11 in the cemented group did not have treatment as defined in the study protocol. I. Patient characteristics. There were no differences in requirements for blood transfusion related to the type of procedure. Among the 400 randomised patients. 1 Allocated to uncemented hemiarthroplasty (200) Treated as per protocol (189) Had internal fixation (2) Prosthesis cemented (7) Pathological fracture (2) Completed follow-up (79) Died during follow-up period (119) Lost to follow-up (2) Participant flow diagram.118 M. Four of these were treated by reduction and internal fixation. were calculated using the Kaplan-Meier method.
7 5.0 1. For the remaining patients the fractures were considered not to require any change in treatment and were managed with the standard mobilisation regimen.4) 67. The patient however made an uneventful recovery.4) 20.5) 24.1 (14.0 In the uncemented group there were 14 intraoperative femoral fractures.9 2.028 0. No. In addition to the details given in Table IV.0 1.8 2.87) 0 2 16. when the implant was converted to a cemented prosthesis. Of these.5) 35 (18) 0. six had the Austin-Moore cemented in place during the procedure.0 < 0. General complications. Characteristics of patients Cemented Thompson Number of patients Mean age (range) Male (%) From own home (%) Mean mobility score Mean mental test score Mean ASA* grade Mean haemoglobin on admission (g/l) 200 83 (61 to 97) 39 (20) 147 (74) 5.7 126 * ASA.3) Uncemented Moore 112 (56) 85 (43) 3 (2) 48.0 1.1 (12. Operative details and hospital stay Cemented Thompson Spinal anaesthesia (%) General anaesthesia (%) Local anaesthesia (%) Mean duration of surgery in mins (SD) Mean duration of anaesthesia in mins (SD) Required blood transfusion (%) Mean units transfused (SD) Operative fracture of the femur Retained cement in acetabulum Orthopaedic ward stay in days (SD) Initial total hospital stay in days (SD) Hospital stay and readmissions in days (SD) 113 (57) 83 (42) 4 (2) 55.0 1.7 (25. two patients had VOL. and one had a revision a few days later.8 (21.0 1. one patient had a cardiac arrest on the operating table after insertion of the cement.5 1. 92-B.4 (13.0001 0.004 * calculated with the Mann-Whitney U and Fisher’s exact tests Table V. JANUARY 2010 cement retained in the acetabulum which was only seen on the post-operative radiograph.0 0.3) 25 (13) 0.1 (13. There were no statistically significant .32 < 0.7 128 Uncemented Moore 200 83 (62 to 104) 53 (27) 145 (73) 5.07 1.20 0.6 (23.0 1.5 (13.02 0. General complications encountered Cemented Thompson Confusion Pneumonia Pressure sores Deep-vein thrombosis Pulmonary embolism Cerebrovascular accident Gastrointestinal bleed Cardiac failure Acute renal failure Myocardial infarction Acute cardiac arrhythmia Acute confusion state Intestinal obstruction Clostridia diarrhoea Peritonitis * calculated with Fisher’s exact tests 2 1 5 2 2 2 4 4 0 1 0 2 0 0 1 Uncemented Moore 2 9 12 2 0 1 0 6 1 2 1 2 1 1 0 p-value* 1.3 (22.39 (0. The general medical complications are listed in Table V. In the cemented hemiarthroplasty group.0 1.CEMENTED VERSUS UNCEMENTED HEMIARTHROPLASTY FOR INTRACAPSULAR HIP FRACTURES 119 Table III. 1.8) p-value* 1.4) 22.12 0.27 (0.72) 14 0 17.006 0. No further treatment was necessary for this.0 0.0 0.9 5.50 0.2) 18.5 (13. American society of anaesthesiologists Table IV.2) 60.0 1.0001 0.0001 < 0.75 1.
PRYOR. G. The mean degree of residual pain for the patients assessed is shown in Table VII and Figure 3. Mobility.25 0.120 M.8 0.6 0.121). Wound healing and implant-related complications. for all the assessments. There was no statistically significant difference between the two groups for the 16 activities assessed.7 weeks vs 23.0045).34 1. These activities were the ability to bend down and pick up an object from the floor (mean 15.0 0. at eight weeks and at three.006) and the ability to go shopping without assistance (mean 16. six.0 0. Later implant-related complications are listed in Table VI. Three of the six patients who were considered unfit for hemiarthroplasty at the time of surgery and were therefore treated by reduction and internal fixation.776 0. except for three in which function was regained more rapidly in those treated by cemented arthroplasty. The mortality at one year for the cemented prosthesis was 25% and for the uncemented was 28% (Fig. The other revisions to hemiarthroplasty or total hip replacement were all for pain in the hip caused by either loosening of the prosthesis or acetabular wear.0 1. 2). The scores were all lower for the cemented prosthesis. I. Activities of daily living. The differences between the admission mobility score and that at each of the post-operative follow-up assessments are shown in Table VIII.0002).0 weeks. Residual pain.1 weeks vs 15. At no time was there any statistically significant difference between the groups.24). Mortality. Of the 200 patients 173 (86%) treated with a cemented implant compared to 164 of 200 patients (82%) with an uncemented implant returned to their original residence after their initial hospital stay (p = 0.6 weeks vs 27. The group of patients treated by the cemented prosthesis had lower pain scores. as opposed to 114 of 138 (83%) in the uncemented group (p = 0. signifying that patients so treated regained a better degree of mobility.27).2 0 0 12 24 36 48 60 Time (mths) Fig. K. Return home. Wound healing complications and later complications related to surgery Cemented Thompson Wound haematoma Superficial wound infection Deep wound infection Dislocation Drainage of infection or haematoma Internal fixation revised to hemiarthroplasty Revision arthroplasty for periprosthetic fracture Revision for pain to THR† Revision for dislocation to THR Girdlestone arthroplasty Girdlestone arthroplasty and later THR Any re-operation * calculated with Fisher’s exact tests † THR.6 weeks. p = 0.0 1. In total 21 further anaesthetics were required in 11 patients in the cemented group compared to 21 further anaesthetics in 18 patients in the uncemented group.0 1. 126 of 143 (88%) in the cemented group were still in their original residence. although only the results on the visual analogue scale.5 0. developed nonunion and had the fixation revised to a hemiarthroplasty.0 1.9 weeks (p = 0. 12 and 24 months by telephone assessment were statistically significant.4 0. THE JOURNAL OF BONE AND JOINT SURGERY .25 differences between the two groups apart from an increased incidence of pneumonia in those treated with an uncemented prosthesis. The remaining patients died in hospital.0 1. p = 0. signifying less pain. 2 Survival curve showing mortality related to the type of procedure. A total of 13 patients (7%) treated with an uncemented prosthesis were unable to be discharged to their original residence or required a more dependent residential status (p = 0. the ability to get in and 1 Cumulative survival (%) Cemented hemiarthroplasty Uncemented hemiarthroplasty p = 0. out of a car (mean 9. Of the surviving patients one year after injury. total hip replacement 2 4 6 2 3 1 0 3 1 1 2 11 Uncemented Moore 1 3 5 1 4 2 3 7 1 1 0 18 p-value* 1. PARKER.0 1. GURUSAMY Table VI.
. the large number of patients included. 92-B. The outcome of revision rate for this population is not so significant as that for elective hip arthroplasty.0 (1. 26) Uncemented Moore 3.155 < 0.5 (1. pain and return of function. Similar findings were recorded in a later study of 50 patients which compared a cemented and an uncemented bipolar hemiarthroplasty. but the questions used form the basis of most of the arthroplasty assessment scores which have been widely used and validated. 160) (1. when a p-value of < 0. If this is applied to the key outcome measure of residual pain. This is comparable with the finding in this study of a rate of revision to total hip replacement of 3% for the cemented Thompson and 6% for the uncemented Austin-Moore.10 in 1982. 0.5 2.e.5 3 months 6 months 9 months 8 weeks 2 years 3 years 4 years 5 years 1 year 1 Fig.2. Walter and Jensen. The outcome of secondary surgery. For 15 000 registered cases. 102) 2.4. This may result in an α error.4. 1.3. a p-value of 0. compared the results of a cemented and an uncemented Austin-Moore hemiarthroplasty in 112 patients.11 There was no difference in mortality between the groups. Better walking ability and less pain was observed in those treated with the cemented prosthesis.05/50 (i. 81) 1. as the elderly population in this study are less likely to undergo a revision arthroplasty.1 We were able to demonstrate that the marginally increased operation time and the potential operative complications associated with cement were not detrimental.4 (1.006 0.7 1.034 0.2. number) Time from surgery to assessment Eight weeks visual analogue Eight weeks Three months Six months Nine months One year Two years Three years Four years Five years Cemented Thompson 2.001) for the uncemented prosthesis. 110) (1.3. fewer re-operations and a shorter hospital stay with the cemented prosthesis. We are not aware of any studies that have specifically validated the Charnley pain score.1. but significantly less pain in those treated with the cemented . 131) 2.7 (1.5 (1. although there was a tendency to more revision arthroplasties in the uncemented group. At the initial outpatient visit we assessed pain using both a visual analogue scale and a pain score as described by Charnley.8.001 0. 156) 2.2. 142) 2. Data from the Australian National Joint Replacement Registry9 have demonstrated a reduced need for revision surgery for a cemented Thompson prosthesis compared with an uncemented Austin-Moore.2.8 (1.001) may be used.3. Discussion This study is the largest randomised trial to date on this topic and confirms the results of the previous smaller studies of patients with an intracapsular hip fracture which found that a cemented hemiarthroplasty leads to less residual pain and a better return of mobility than an uncemented prosthesis.6 1.2. in which. The Australian database found that four years after surgery the rate of revision was approximately 4% for the Thompson versus 6% for the Austin-Moore prosthesis.1 (1.258 0. 160) 2.2 (1. even if significant symptoms of residual pain exist.1 Sonne-Holm.029 0.8 1. No. Hence. Mean degree of residual pain at the follow-up assessments (SD. There was no difference in mortality between the two groups. 133) 2.7 (1. with a clear trend to fewer general medical complications.8 1. Indeed. particularly revision of the implant.5 2 1. JANUARY 2010 Many outcome measures were used in this study (approximately 50 comparisons). The most important outcomes measured were mortality. 100) 1.05 is chosen as the level of statistical significance.2. the lack of patients lost to follow-up.3 22.214.171.124 (2. Previously published randomised trials comparing cemented and uncemented hemiarthroplasties for patients with a fracture of the hip have been identified and summarised in the Cochrane Review on this subject. Using a Bonferroni correction. 164) (1. this still remains statistically significant.3.3. 136) (1.2. 32) p-value* 0.0001 0.2 (1.9 1.CEMENTED VERSUS UNCEMENTED HEMIARTHROPLASTY FOR INTRACAPSULAR HIP FRACTURES 121 Table VII. one result in 20 may show such a p-value. 141) (1. standardisation of treatment procedures. The strengths of this study include the broad entry criteria. was not significantly different between the two groups. 147) (1.3. the rate of revision surgery was significantly higher (p < 0.95 0. and the blinded assessment of outcome.2.9 1. the reverse was true.7 1.30 * calculated with the Mann-Whitney U test Cemented 3 Pain score Uncemented 2. 47) (1. 50) 2. 70) (1.034 0. 3 Graph showing mean pain scores related to the type of treatment given. VOL.5 For this elderly population it was found that the Charnley pain score was the most appropriate method of assessment for follow-up by telephone. the key finding in this study of reduced residual pain for the cemented prosthesis is extremely unlikely to be due to statistical chance. 96) (1.
53:953-6. In conjunction with previous studies which have also reported improved outcomes for a cemented rather than an uncemented hemiarthroplasty. K. 7. Age Ageing 1974. Santini et al12 also compared a cemented and an uncemented bipolar hemiarthroplasty in 106 patients. 6. Harper WM. Quereshi KN.4 1. Parker MJ. Santini S. Norman. 12. 144) (2. 9.42 0. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Injury 2002.10 0. 137) (2. Parker MJ. Srivastiva VM. The long-term results of low-friction arthroplasty of the hip performed as a primary intervention. 4. J Bone Joint Surg [Br] 1972. Desal K.0. A survey of the treatment of displaced intracapsular femoral neck fractures in the UK. 5. Meier P.73-B:322-4.75-B:797-8. 158) (1. Parker and K. Both reported no statistically significant difference between the groups for mortality. 168) (2.au/aoanjrr/index. Dripps RD. 14. there was no difference in mortality or functional activity between the two groups.31:280-1. 16. Gurusamy K.0.81 * calculated with the Mann-Whitney U test prosthesis. GURUSAMY Table VIII. Moulton AM.24:111. Prince HG. 11. Walter S. THE JOURNAL OF BONE AND JOINT SURGERY .26 0. Ruggerio for their help with the study.33:383-6. It is possible that a modern uncemented prosthesis. number) Time from surgery to assessment Eight weeks visual analogue Three months Six months Nine months One year Two years Three years Four years Five years Cemented Thompson 2. Livesley PJ. 15. Broughton NS.4 (2. PRYOR.5 (2. D. The only study that has compared an uncemented Austin-Moore with a hydroxyapatite-coated Furlong prosthesis in 84 patients was too small to make any definite conclusions on any difference between the two implants.2 1. Charnley J. this study found that a cemented Thompson hemiarthroplasty led to less pain in the hip. Anaesthesiology 1963. No authors listed.1 1.1.8 1. PARKER.16 In summary. Sonne-Holm S. Kaplan EL. perhaps with hydroxyapatite coating may produce superior outcomes to the uncemented Austin-Moore prosthesis which we used. Crossman PT. In: The Cochrane Library. 142) (1. Turi G.1. Jensen JS. (Cochrane Review). National Joint Replacement Register.4 2. New classification of physical status. Khan RJK. although the results were not statistically significant. J Bone Joint Surg [Br] 1991. 168) (1.9. Vanis R. Ekdahl C. Bandholm T.2. J Arthroplasty 1986.005 0.54-B:61-76.1:210-18. Palmer CR.016 0.07 0. Evaluation of a ten-question mental test in the institutionalised elderly. Injury 2000.3. I. Australian Orthopaedic Association. References 1. Treatment of femoral neck fractures with total hip replacement versus cemented and noncemented hemiarthroplasty.0 2. Rebeccato A. Moore hemi-arthroplasty with and without bone cement in femoral neck fractures: a clinical controlled trial.0 2. http://www. Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. J Rehabil Med 2008. 107) (2. and significantly more residual pain in those treated with an uncemented prosthesis. Acta Orthop Scand 1982. 165) (2. 10. J Bone Joint Surg [Br] 1992.0. 29) Uncemented Moore 2. Use of a hydroxyapatite-coated hemiarthroplasty in the management of subcapital fracture of the femur. Hodkinson HM. High inter-tester reliability of the new mobility score in patients with hip fracture.3. Chandler R. 52) (2.9. The mean pain scores in the 70 surviving patients tended to be higher. Emery RJH.0. Faraj AA.9 2.8. 73) (2. 104) (2. Nonparametric estimation from incomplete observations.7 2. Faraj and Porter15 also compared a cemented with an uncemented Thompson prosthesis in 91 patients and reported no significant difference in mortality. Injury 1993.53:457-81. for the uncemented prosthesis. 50) (2.004 0. 150) (1. J Bone Joint Surg [Br] 1993. et al.74-B(Suppl 2):132-3. Kehlet H. Hoskinson J.1. 34) p-value* 0.0.40:589-91. J Orthop Traumatology 2005. We chose the two prostheses used in this study as they are currently the most commonly used in the United Kingdom. Branfoot T.3 1.3 1. Two studies involving a total of 190 patients compared a cemented with an uncemented Thompson prosthesis. Glousman R. Cemented versus uncemented Thompson’s prosthesis: a randomised prospective functional outcome study. 8. The study was supported by a grant from the Peterborough Hospital Hip Fracture Fund.6:80-7. Dias JJ. Anderson GH. J Am Stat Assoc 1958. MacDowell A. Thomas TL. Chichester: Wiley.jsp (date last accessed 9 September 2009).13. 83) (2. Walking ability was also superior with the cemented prosthesis. but this remains to be proved in a randomised controlled trial. Hip fractures in elderly patients treated with bipolar hemiarthroplasty: comparison between cemented and cementless implants.2 2. Dorr LD.dmac.edu. 135) (2. Foss NB.3:152-7.24:236-40. Porter P. 13. Bulstrode CJK. There was no increase in complications or mortality related to the use of cement. Needoff M. Sew Hoy AL.1. indicating more pain.7 2. G. 3.9 2. A new mobility score for predicting mortality after hip fracture.adelaide.2.14 Branfoot. Bolgan I. 2.5 2.2. 143) (2. Again. improved return of mobility and a reduced hospital stay compared to an uncemented Austin-Moore prosthesis.122 M. Kristensen MT.9. M. 2006. We would like to thank the research nurses N. Mean reduction in mobility scores (SD.58 0.0 2. Smith. Bipolar hemiarthroplasty for subcapital fracture of the femoral neck: a prospective randomised trial of cemented Thompson and uncemented Moore stems. we suggest that when a hemiarthroplasty is used for a fracture of the hip it should be cemented in place. A randomized study of the use of bone cement with Thompson’s prosthesis in the treatment of intracapsular fractures of the femoral neck.
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