Hemiarthroplasty using cemented or uncemented stems of proven design: a comparative study

Area of Science:

• Orthopaedic surgery
• Biomaterials science

Background:

• National Institute of Clinical Excellence guidelines recommend cemented stems (Orthopaedic Data Evaluation Panel (ODEP) rating > 3B) for hemiarthroplasty in intracapsular femoral neck fractures.
• Existing recommendations may not reflect current stem ratings, as many studied stems lacked high ODEP ratings.

Purpose of the Study:

• To compare the outcomes of cemented (Exeter) versus uncemented (Corail) femoral stems in hip hemiarthroplasty for intracapsular femoral neck fractures.
• To evaluate complications, re-operations, and mortality rates associated with each stem type.

Main Methods:

• A case-control study was conducted using data from two centers, comparing cemented Exeter and uncemented Corail femoral stems.
• Patients were matched for factors influencing mortality after femoral neck fracture.
• Outcome measures included intra-operative complications, early and late post-operative complications, re-operations, and mortality at 2, 7, 30, and 365 days.

Main Results:

• Comparable overall outcomes were observed between cemented and uncemented stems.
• The uncemented group experienced more intra-operative complications (13% vs. 0%).
• The cemented group had higher early post-operative mortality (n=6), but no significant difference in re-operation rates (5%) or 365-day mortality (26%) between groups.

Conclusions:

• Both cemented and uncemented femoral stems of proven design (e.g., ODEP 10A rating) are suitable for hemiarthroplasty in patients with intracapsular femoral neck fractures.
• The study supports the use of both stem types, challenging previous guideline assumptions.
• Clinical decision-making should consider the proven track record and ODEP rating of the chosen prosthesis.