Higher rate of complications with uncemented compared to cemented total hip arthroplasty for displaced intracapsular hip fractures: A randomised controlled trial of 50 patients
Clement, Nicholas D.
van der Linden, Marietta
Keating, John F.
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Clement, N. D., van der Linden, M. & Keating, J. F. (2020) Higher rate of complications with uncemented compared to cemented total hip arthroplasty for displaced intracapsular hip fractures: A randomised controlled trial of 50 patients. European Journal of Orthopaedic Surgery & Traumatology (In Press).
Background The primary aim of this study was to compare the functional outcome of uncemented with cemented total hip arthroplasty (THA) for displaced intracapsular hip fractures. The secondary aims were to assess length of surgery, blood loss, complications and revision rate between the two groups.Methods A prospective double-blind randomised control trial was conducted. Fifty patients’ staining an intracapsular hip fracture meeting the inclusion criteria and were randomised to either an uncemented (n=25) or cemented (n=25) THA. There were no differences (p>0.45) in age, gender, health status or preinjury hip function between the groups. The Oxford hip score (OHS), Harris Hip score (HHS), EuroQol 5-dimensional (EQ5D), timed get up-and-go (TUG), pain and patient satisfaction were used to assess outcome. These were assessed at 4, 12 and 72 months after surgery, apart from the TUG which as only assessed as 6 months.Results The study was terminated early due to the significantly (n=8, p=0.004) higher rate of intraoperative complications in the uncemented group: three fractures of the proximal femur and five conversions to a cemented acetabular component. There were no significant (p≥0.09) differences in the functional measures (OHS, HSS, EQ5D, TUG and pain) or patient satisfaction between the groups. There was no difference in operative time (p=0.75) or blood loss (p=0.66) between the groups. There were two early revisions prior to 3-months postoperatively in the uncemented group and none in the cemented group, but this was not significant (Log Rank p=0.16).Conclusion There was a high rate of intraoperative complications, which may be due to poor bone quality in this patient group. There were no ergonomic or functional advantages demonstrated between uncemented and cemented THA. Cemented THA should remain as the preferred choice for the treatment of intracapsular hip fractures for patients that meet the criteria for this procedure.