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Published on: June 6, 2025
Cemented versus uncemented hemiarthroplasty for hip fractures: a systematic review of randomised controlled trials
Shin Azegami1, Kurinchi S Gurusamy, Martyn J Parker
1Department of Orthopaedic Surgery, Peterborough District Hospital, Peterborough, UK. azegami@hotmail.com
Insights
Cemented hemiarthroplasty for hip fractures shows better pain reduction and functional recovery compared to uncemented options. This systematic review found cemented prostheses led to less residual hip pain and improved mobility, with no increased mortality risks.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
Background:
- Intracapsular hip fractures are common, particularly in elderly patients.
- Hemiarthroplasty is a standard surgical treatment for these fractures.
- The choice between cemented and uncemented prosthesis fixation is a key clinical decision.
Purpose of the Study:
- To systematically review randomized controlled trials (RCTs).
- To compare outcomes of cemented versus uncemented hemiarthroplasty for intracapsular hip fractures.
- To provide evidence-based guidance for clinical practice.
Main Methods:
- Systematic review and meta-analysis of RCTs.
- Comprehensive literature search across multiple databases (Cochrane, EMBASE, MEDLINE, etc.).
- Inclusion of eight studies with 1169 patients.
Main Results:
- Cemented prostheses had longer operative times.
- Cemented hemiarthroplasty resulted in a lower reduction in mobility score.
- Fewer patients experienced residual hip pain with cemented prostheses, indicated by lower pain scores.
Conclusions:
- Cemented hemiarthroplasty provides superior pain relief and functional restoration compared to uncemented options.
- No significant adverse effects of cement on mortality or other complications were identified.
- Further RCTs are needed to compare modern hydroxyapatite-coated stems with cemented prostheses.
Abstract:
We performed a systematic review of randomised controlled trials in order to identify the best available evidence to compare the outcome between cemented and uncemented hemiarthroplasty for treatment of intracapsular hip fractures. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, MEDLINE and the National Research Register (UK) to retrieve all of the published randomised controlled trials designed to address these issues, in order to perform a meta-analysis. Eight studies involving 1169 patients were determined to be appropriate for meta-analysis. The following statistically significant differences were found between the cemented and uncemented prostheses: (1) longer operative time for cemented prosthesis; (2) lower reduction in mobility score for those treated with cemented prosthesis; (3) fewer patients with residual pain in the hip and lower pain score (signifying less pain) for those treated with a cemented prosthesis. Our meta-analysis has shown that there is good evidence that the use of cement during hemiarthroplasty will reduce the amount of residual hip pain and also allow better restoration of function. There is no evidence of significant adverse effects of cement on mortality or other complications encountered. These observations apply to older designs, and there is a need for randomised trials comparing hydroxyapatite-coated modern stems with cemented prostheses.
