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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
6. Bed or chair bound .CEMENTED VERSUS UNCEMENTED HEMIARTHROPLASTY FOR INTRACAPSULAR HIP FRACTURES 117 Table I. Cirencester. Subsequent assessments were by telephone at three. 3. For those patients who could not be contacted. five constant but bearable pain. Before commencing the study a power calculation was undertaken using the primary outcome of degree of residual pain at one year. They were discharged home as soon as their general condition allowed. and all results were analysed on an intention-to-treat basis. and continuous outcomes with the Mann-Whitney U test. United Kingdom) was generally of the standard size.score 3 On their own with an aid .5 The one to six assessment scale was used for telephone follow-up assessments. two after four years and one after three years. enquiry was made via their next of kin or their registered medical practitioner. After surgery all patients were mobilised as soon as they were able.3. Statistical analysis. 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. 2. Binary outcomes for the two groups were analysed using Fisher’s exact test. four with no or little pain at rest. frequent mild analgesia. JANUARY 2010 Table II. it was estimated that 200 patients were required in each group. 92-B.7 years (2 to 5). with no restrictions on hip movements or weight-bearing. 1. Newbury. with least pain scoring one. if the patient could not be contacted. regardless of any deviations from the treatment protocol. and thereafter every year for up to five years. The patient’s walking ability immediately prior to the fall was assessed using a mobility scale of 0 to nine. 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. A Hardinge cement restrictor was used and Palacos bone cement with gentamicin (Schering-Plough Ltd. All operations were performed or supervised by one orthopaedic surgeon (MIP) and all by a standard anterolateral approach with repair of the joint capsule. United Kingdom) was inserted after the femur had been prepared by reaming and saline irrigation. stronger analgesia used occasionally. containing details of the procedure to be undertaken. Patients were initially reviewed six weeks after discharge.score 1 Not at all. After randomisation all patients had to stay in the group to which they had been allotted. pain was assessed using a visual analogue scale of one to ten at the outpatient clinic visit. United Kingdom) was inserted in a retrograde manner into the femur using a cement gun. For the follow-up assessments. All patients received peri-operative antibiotic prophylaxis and 14 days of low molecular weight heparin as thromboembolic prophylaxis. and six constant pain with frequent strong analgesia.score 0 residential care (partial care within an institution) or nursing care (full nursing care or hospital in-patient). Mobility assessment tool 1. Finally. The calculation was based on reducing the number of patients with a pain score of ≥ 3 by 10%.7 where nine represented full mobility indoors and outdoors without walking aids and 0 defined a bedbound patient (Table II). and also using a scale of one to six in which one was no pain. The Austin-Moore prosthesis used (Stryker/Howmedica Ltd. three pain when starting walking but then getting better with occasional analgesia. enquiry was made to the Office of Population Census Service. pain with activities. six. At each follow-up assessment the time until 16 activities of daily living were regained was also assessed. two occasional and slight pain. a narrow-stem implant was used. 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 . All assessments were undertaken by a nurse who was blinded to the treatment undertaken. Three patients were lost to follow-up. All surviving patients had a mean follow-up of 3. Survival outcomes .4 Residential status was defined as living in their own home (including warden-controlled accommodation). No. Welwyn Garden City. VOL. but if the femur was slender. The Thompson hemiarthroplasty (Corin Ltd.score 2 Only with someone else’s help . Allowing for deaths and loss to follow-up. nine and 12 months.
initially considered fit for hemiarthroplasty. The readmissions included were only those for conditions directly related to the hip fracture. One patient was found at the time of surgery to have a trochanteric fracture and not an intracapsular fracture. K. 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. having previously been considered fit for both procedures. The reasons for 700 patients not being included in the study are shown in Figure 1. Total hospital stay was found to be four days shorter for those treated with a cemented prosthesis. and comparison between the groups was performed using the Kaplan-Meier log-rank test.118 M.05 was considered statistically significant. Two patients.8 A p-value of < 0. None of the differences between the two groups was statistically significant. I. and one further patient was later found to have a pathological fracture from a secondary tumour. A further 11 patients in the uncemented group did not have treatment as defined in the study protocol. The characteristics of the two groups of patients are detailed in Table III. were calculated using the Kaplan-Meier method. were considered unfit at the time of surgery and treated by reduction and internal fixation. either because of a large femoral cavity or from an operative fracture of the femur. and the prosthesis was therefore cemented in place. 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. The mean duration of surgery was approximately seven minutes longer for those who had a cemented prosthesis. Seven were felt to have a prosthesis that was loose at the time of surgery. Patient characteristics. but was still treated with a cemented Thompson hemiarthroplasty. PARKER. 11 in the cemented group did not have treatment as defined in the study protocol. and one had an uncemented Austin-Moore hemiarthroplasty. The operative details and total hospital stay for the two groups are shown in Table IV. Four patients were found to have a femur that was too narrow to accommodate a Thompson prosthesis. including medical and rehabilitation wards. Four of these were treated by reduction and internal fixation. PRYOR. Among the 400 randomised patients. Results Patients were recruited over a five-year period. Three were treated with an uncemented narrow-stem Austin-Moore and one with a cemented bipolar hemiarthroplasty. until discharge from hospital.* Patients may have been excluded for more than one reason. G. Five patients were considered to be unfit for a cemented hemiarthroplasty immediately prior to or during surgery. The total hospital stay was the time spent on the orthopaedic and any other wards. A further two patients were later found to have a pathological fracture secondary to a tumour. Operative details. There were no differences in requirements for blood transfusion related to the type of procedure. THE JOURNAL OF BONE AND JOINT SURGERY .
No further treatment was necessary for this.75 1.0 0. 92-B.0 In the uncemented group there were 14 intraoperative femoral fractures. The patient however made an uneventful recovery.4) 22. 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) 55.2) 60.50 0.4 (13. Of these.0 1. and one had a revision a few days later.7 (25.0001 0.CEMENTED VERSUS UNCEMENTED HEMIARTHROPLASTY FOR INTRACAPSULAR HIP FRACTURES 119 Table III.8) p-value* 1.5 1.20 0. General complications. JANUARY 2010 cement retained in the acetabulum which was only seen on the post-operative radiograph.006 0.0 1.9 5.0001 < 0.32 < 0.02 0.72) 14 0 17.0 < 0.0 1. The general medical complications are listed in Table V.9 2.0 1.004 * calculated with the Mann-Whitney U and Fisher’s exact tests Table V.12 0.7 5.07 1.0 0. two patients had VOL. For the remaining patients the fractures were considered not to require any change in treatment and were managed with the standard mobilisation regimen.4) 20.5) 35 (18) 0.4) 67. 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. There were no statistically significant .3 (22.0 0.1 (13.39 (0. when the implant was converted to a cemented prosthesis.028 0.3) Uncemented Moore 112 (56) 85 (43) 3 (2) 48. 1.5 (13.0 1. In addition to the details given in Table IV.0 1.5 (13. In the cemented hemiarthroplasty group.8 2.1 (12.1 (14.27 (0.7 128 Uncemented Moore 200 83 (62 to 104) 53 (27) 145 (73) 5.87) 0 2 16. No.0001 0.7 126 * ASA. 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. six had the Austin-Moore cemented in place during the procedure.0 1.6 (23. American society of anaesthesiologists Table IV.3) 25 (13) 0.5) 24. one patient had a cardiac arrest on the operating table after insertion of the cement.2) 18.0 1.8 (21.
0 weeks.4 0. 126 of 143 (88%) in the cemented group were still in their original residence.9 weeks (p = 0. Of the surviving patients one year after injury. 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. Return home. PRYOR. I. six. out of a car (mean 9.0 1. 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. 2 Survival curve showing mortality related to the type of procedure.0045).7 weeks vs 23. The mortality at one year for the cemented prosthesis was 25% and for the uncemented was 28% (Fig. 2).6 weeks vs 27. Activities of daily living. 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.27).6 0.25 differences between the two groups apart from an increased incidence of pneumonia in those treated with an uncemented prosthesis.0 0.006) and the ability to go shopping without assistance (mean 16. p = 0. the ability to get in and 1 Cumulative survival (%) Cemented hemiarthroplasty Uncemented hemiarthroplasty p = 0. The remaining patients died in hospital.0 1. Wound healing and implant-related complications.120 M. G. At no time was there any statistically significant difference between the groups. The scores were all lower for the cemented prosthesis. developed nonunion and had the fixation revised to a hemiarthroplasty.0 1. These activities were the ability to bend down and pick up an object from the floor (mean 15.0 0. as opposed to 114 of 138 (83%) in the uncemented group (p = 0. although only the results on the visual analogue scale.0 1. Residual pain. There was no statistically significant difference between the two groups for the 16 activities assessed.1 weeks vs 15.0 1.0 1. 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. at eight weeks and at three.24).0002). PARKER. signifying that patients so treated regained a better degree of mobility.5 0. Mobility.6 weeks. for all the assessments. 12 and 24 months by telephone assessment were statistically significant. The group of patients treated by the cemented prosthesis had lower pain scores. 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.8 0. The differences between the admission mobility score and that at each of the post-operative follow-up assessments are shown in Table VIII. THE JOURNAL OF BONE AND JOINT SURGERY . 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. except for three in which function was regained more rapidly in those treated by cemented arthroplasty. GURUSAMY Table VI.34 1. The mean degree of residual pain for the patients assessed is shown in Table VII and Figure 3.121). Later implant-related complications are listed in Table VI. p = 0.2 0 0 12 24 36 48 60 Time (mths) Fig. signifying less pain. K.25 0.776 0. Mortality. 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.
e.7 1. We are not aware of any studies that have specifically validated the Charnley pain score.05/50 (i. At the initial outpatient visit we assessed pain using both a visual analogue scale and a pain score as described by Charnley.3 1. 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. 110) (1.2.155 < 0. The most important outcomes measured were mortality.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.4.4 (1. 131) 2. standardisation of treatment procedures. The outcome of secondary surgery.2. 70) (1.2. 133) 2. 92-B. 96) (1.5 3 months 6 months 9 months 8 weeks 2 years 3 years 4 years 5 years 1 year 1 Fig. 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. and the blinded assessment of outcome. one result in 20 may show such a p-value.3.2 (1. the key finding in this study of reduced residual pain for the cemented prosthesis is extremely unlikely to be due to statistical chance.258 0. 26) Uncemented Moore 3. but the questions used form the basis of most of the arthroplasty assessment scores which have been widely used and validated. Mean degree of residual pain at the follow-up assessments (SD.006 0.10 in 1982. 164) (1.2.1. 81) 1. compared the results of a cemented and an uncemented Austin-Moore hemiarthroplasty in 112 patients. pain and return of function.2.001) for the uncemented prosthesis. the rate of revision surgery was significantly higher (p < 0. 3 Graph showing mean pain scores related to the type of treatment given.1 (1.5 2.029 0. 32) p-value* 0. 141) (1. Using a Bonferroni correction.95 0. 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.CEMENTED VERSUS UNCEMENTED HEMIARTHROPLASTY FOR INTRACAPSULAR HIP FRACTURES 121 Table VII.5 (1. Hence.0001 0. 156) 2.8.4. For 15 000 registered cases.3. even if significant symptoms of residual pain exist.001 0.7 1. 0. the lack of patients lost to follow-up. 102) 2.7 (1. The strengths of this study include the broad entry criteria. but significantly less pain in those treated with the cemented .2. this still remains statistically significant. No.11 There was no difference in mortality between the groups.034 0. 1. There was no difference in mortality between the two groups. a p-value of 0.9 1.3.05 is chosen as the level of statistical significance. particularly revision of the implant. If this is applied to the key outcome measure of residual pain. 136) (1.1 (2. This may result in an α error. Better walking ability and less pain was observed in those treated with the cemented prosthesis. as the elderly population in this study are less likely to undergo a revision arthroplasty.3.0 (1.8 1. the large number of patients included.3. 47) (1. 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. The outcome of revision rate for this population is not so significant as that for elective hip arthroplasty. VOL. 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.6 1.3. 142) 2. 160) 2.3. 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. 100) 1..1 Sonne-Holm.2. with a clear trend to fewer general medical complications. Walter and Jensen.30 * calculated with the Mann-Whitney U test Cemented 3 Pain score Uncemented 2. when a p-value of < 0.8 1.001) may be used. JANUARY 2010 Many outcome measures were used in this study (approximately 50 comparisons). 160) (1.8 (1. although there was a tendency to more revision arthroplasties in the uncemented group.7 (1.9 1. Similar findings were recorded in a later study of 50 patients which compared a cemented and an uncemented bipolar hemiarthroplasty.1 We were able to demonstrate that the marginally increased operation time and the potential operative complications associated with cement were not detrimental. the reverse was true. in which.5 2 1.1.2 (1. Indeed.034 0.2. fewer re-operations and a shorter hospital stay with the cemented prosthesis. 147) (1. 50) 2. was not significantly different between the two groups.5 (1.
107) (2.4 1.004 0. 12.3. Chichester: Wiley. Smith.74-B(Suppl 2):132-3.9 2. 158) (1.2. Parker and K. and significantly more residual pain in those treated with an uncemented prosthesis. Both reported no statistically significant difference between the groups for mortality. Hoskinson J. J Bone Joint Surg [Br] 1992. 34) p-value* 0. Walking ability was also superior with the cemented prosthesis. 10. Nonparametric estimation from incomplete observations.53:953-6. 4. Emery RJH. Khan RJK. 144) (2. In conjunction with previous studies which have also reported improved outcomes for a cemented rather than an uncemented hemiarthroplasty. No authors listed. 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. The study was supported by a grant from the Peterborough Hospital Hip Fracture Fund. Broughton NS. Kehlet H.au/aoanjrr/index. Ruggerio for their help with the study. Two studies involving a total of 190 patients compared a cemented with an uncemented Thompson prosthesis. Srivastiva VM. Rebeccato A. Bolgan I. Hodkinson HM.3:152-7.2 2. MacDowell A. Charnley J. J Rehabil Med 2008. Injury 2002. 150) (1.1. 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 2.1. J Arthroplasty 1986. Treatment of femoral neck fractures with total hip replacement versus cemented and noncemented hemiarthroplasty. THE JOURNAL OF BONE AND JOINT SURGERY .0.0.4 (2.81 * calculated with the Mann-Whitney U test prosthesis. 2006. M. New classification of physical status.9. Needoff M. Faraj and Porter15 also compared a cemented with an uncemented Thompson prosthesis in 91 patients and reported no significant difference in mortality.0 2. Harper WM. http://www. Anaesthesiology 1963. 29) Uncemented Moore 2. we suggest that when a hemiarthroplasty is used for a fracture of the hip it should be cemented in place.10 0. A randomized study of the use of bone cement with Thompson’s prosthesis in the treatment of intracapsular fractures of the femoral neck. 165) (2. 135) (2. 83) (2.54-B:61-76.adelaide. Prince HG. J Bone Joint Surg [Br] 1972. Parker MJ. Quereshi KN.8.75-B:797-8. I. K. Walter S.13. improved return of mobility and a reduced hospital stay compared to an uncemented Austin-Moore prosthesis. there was no difference in mortality or functional activity between the two groups. Evaluation of a ten-question mental test in the institutionalised elderly.7 2. 137) (2. 168) (1.6:80-7. 50) (2. We would like to thank the research nurses N.24:236-40. Meier P.40:589-91.9. 11. Parker MJ. this study found that a cemented Thompson hemiarthroplasty led to less pain in the hip. Moulton AM.jsp (date last accessed 9 September 2009). Injury 1993. J Bone Joint Surg [Br] 1993.16 In summary.dmac.0 2. Livesley PJ.07 0. 2. In: The Cochrane Library. PARKER. perhaps with hydroxyapatite coating may produce superior outcomes to the uncemented Austin-Moore prosthesis which we used. (Cochrane Review).122 M. Thomas TL.53:457-81. Bulstrode CJK. Turi G. GURUSAMY Table VIII.4 2.24:111. D. Injury 2000. Gurusamy K.3 1. Santini et al12 also compared a cemented and an uncemented bipolar hemiarthroplasty in 106 patients. Branfoot T. although the results were not statistically significant. Kristensen MT. Norman. 8. Cemented versus uncemented Thompson’s prosthesis: a randomised prospective functional outcome study. et al. Chandler R. Ekdahl C. Australian Orthopaedic Association. Faraj AA. A survey of the treatment of displaced intracapsular femoral neck fractures in the UK. Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. 73) (2. for the uncemented prosthesis.0 2. Foss NB. 143) (2. National Joint Replacement Register. Mean reduction in mobility scores (SD. Use of a hydroxyapatite-coated hemiarthroplasty in the management of subcapital fracture of the femur. J Orthop Traumatology 2005.73-B:322-4. 16. J Am Stat Assoc 1958. Jensen JS. References 1. Bipolar hemiarthroplasty for subcapital fracture of the femoral neck: a prospective randomised trial of cemented Thompson and uncemented Moore stems. 6. G.5 (2.7 2. 14.9.5 2. Again.0. 104) (2. Kaplan EL.005 0. indicating more pain.016 0.edu. Dripps RD. 168) (2. Dorr LD. Moore hemi-arthroplasty with and without bone cement in femoral neck fractures: a clinical controlled trial.2 1. 142) (1. It is possible that a modern uncemented prosthesis. Crossman PT.1. 3.0. Dias JJ. 15. 13.58 0.42 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. but this remains to be proved in a randomised controlled trial.3.9 2. Anderson GH.14 Branfoot.31:280-1. Age Ageing 1974.2. Santini S.3 1. 52) (2. The mean pain scores in the 70 surviving patients tended to be higher. J Bone Joint Surg [Br] 1991. A new mobility score for predicting mortality after hip fracture. 9.2. Desal K.1:210-18. 7. Porter P. There was no increase in complications or mortality related to the use of cement.26 0. Hip fractures in elderly patients treated with bipolar hemiarthroplasty: comparison between cemented and cementless implants. Palmer CR. We chose the two prostheses used in this study as they are currently the most commonly used in the United Kingdom. High inter-tester reliability of the new mobility score in patients with hip fracture. The long-term results of low-friction arthroplasty of the hip performed as a primary intervention. Sonne-Holm S. 5. Bandholm T.1.0. Acta Orthop Scand 1982. Glousman R.1 1.33:383-6. Vanis R.8 1. PRYOR. Sew Hoy AL.
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