The Comparison between Cemented and Uncemented Hemiarthroplasty in Patients with Femoral Neck Fractures: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
Cement
Femoral neck fractures
Hemiarthroplasty
Uncemented
Journal
Orthopaedic surgery
ISSN: 1757-7861
Titre abrégé: Orthop Surg
Pays: Australia
ID NLM: 101501666
Informations de publication
Date de publication:
Jul 2023
Jul 2023
Historique:
revised:
24
02
2023
received:
19
10
2022
accepted:
06
03
2023
medline:
18
7
2023
pubmed:
8
5
2023
entrez:
8
5
2023
Statut:
ppublish
Résumé
Hemiarthroplasty is the standard treatment for patients with femoral neck fractures (FNFs). Controversy exists over the use of bone cement in hip fractures treated with hemiarthroplasty. We performed an updated systematic review and meta-analysis to compare cemented and uncemented hemiarthroplasty in patients with femoral neck fractures. A literature review was conducted using Cochrane Library, ScienceDirect, PubMed, Embase, Medline, Web of Science, CNKI, VIP, Wang Fang, and Sino Med databases. Studies comparing cemented with uncemented hemiarthroplasty for FNFs in elderly patients up to June 2022 were included. Data were extracted, meta-analyzed, and pooled as risk ratios (RRs) and weighted mean differences (WMDs) with a 95% confidence interval (95% CI). Twenty-four RCTs involving 3471 patients (1749 cement; 1722 uncemented) were analyzed. Patients with cemented intervention had better outcomes regarding hip function, pain, and complications. Significant differences were found in terms of HHS at 6 weeks (WMD 12.5; 95% CI 6.0-17.0; P < 0.001), 3 months (WMD 3.3; 95% CI 1.6-5.0; P < 0.001), 4 months (WMD 7.3; 95% CI 3.4-11.2; P < 0.001), and 6 months (WMD 4.6; 95% CI 3.3-5.8; P < 0.001) postoperatively. Patients with cemented hemiarthroplasty had lower rates of pain (RR 0.59; 95% CI 0.39-0.9; P = 0.013), prosthetic fracture (RR 0.24; 95% CI 0.16-0.38; P < 0.001), subsidence/loosening (RR 0.29; 95% CI 0.11-0.78; P = 0.014), revisions (RR 0.59; 95% CI 0.40-0.89; P = 0.012), and pressure ulcers (RR 0.43; 95% CI 0.23-0.82; P = 0.01) at the expense of longer surgery time (WMD 7.87; 95% CI 5.71-10.02; P < 0.001). This meta-analysis demonstrated that patients with cemented hemiarthroplasty had better results in hip function and pain relief and lower complication rates at the expense of prolonged surgery time. Cemented hemiarthroplasty is recommended based on our findings.
Sections du résumé
BACKGROUND
BACKGROUND
Hemiarthroplasty is the standard treatment for patients with femoral neck fractures (FNFs). Controversy exists over the use of bone cement in hip fractures treated with hemiarthroplasty.
OBJECTIVE
OBJECTIVE
We performed an updated systematic review and meta-analysis to compare cemented and uncemented hemiarthroplasty in patients with femoral neck fractures.
METHODS
METHODS
A literature review was conducted using Cochrane Library, ScienceDirect, PubMed, Embase, Medline, Web of Science, CNKI, VIP, Wang Fang, and Sino Med databases. Studies comparing cemented with uncemented hemiarthroplasty for FNFs in elderly patients up to June 2022 were included. Data were extracted, meta-analyzed, and pooled as risk ratios (RRs) and weighted mean differences (WMDs) with a 95% confidence interval (95% CI).
RESULTS
RESULTS
Twenty-four RCTs involving 3471 patients (1749 cement; 1722 uncemented) were analyzed. Patients with cemented intervention had better outcomes regarding hip function, pain, and complications. Significant differences were found in terms of HHS at 6 weeks (WMD 12.5; 95% CI 6.0-17.0; P < 0.001), 3 months (WMD 3.3; 95% CI 1.6-5.0; P < 0.001), 4 months (WMD 7.3; 95% CI 3.4-11.2; P < 0.001), and 6 months (WMD 4.6; 95% CI 3.3-5.8; P < 0.001) postoperatively. Patients with cemented hemiarthroplasty had lower rates of pain (RR 0.59; 95% CI 0.39-0.9; P = 0.013), prosthetic fracture (RR 0.24; 95% CI 0.16-0.38; P < 0.001), subsidence/loosening (RR 0.29; 95% CI 0.11-0.78; P = 0.014), revisions (RR 0.59; 95% CI 0.40-0.89; P = 0.012), and pressure ulcers (RR 0.43; 95% CI 0.23-0.82; P = 0.01) at the expense of longer surgery time (WMD 7.87; 95% CI 5.71-10.02; P < 0.001).
CONCLUSION
CONCLUSIONS
This meta-analysis demonstrated that patients with cemented hemiarthroplasty had better results in hip function and pain relief and lower complication rates at the expense of prolonged surgery time. Cemented hemiarthroplasty is recommended based on our findings.
Identifiants
pubmed: 37154088
doi: 10.1111/os.13716
pmc: PMC10350391
doi:
Substances chimiques
Bone Cements
0
Types de publication
Meta-Analysis
Systematic Review
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1719-1729Subventions
Organisme : West China Nursing Discipline Development Special Fund Project, Sichuan University
ID : HXHL20003
Organisme : West China Nursing Discipline Development Special Fund Project, Sichuan University
ID : HXHL20006
Organisme : 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University
ID : ZYJC18040
Organisme : The Key Research & Development program of the Science & Technology Department of Sichuan Province
ID : 2021YFS0167
Organisme : Post-Doctor Research Project, West China Hospital, Sichuan University
ID : 2020HXBH080
Informations de copyright
© 2023 The Authors. Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.
Références
Acta Orthop. 2018 Oct;89(5):509-514
pubmed: 30080985
Osteoporos Int. 1997;7(5):407-13
pubmed: 9425497
Bone Joint J. 2020 Jan;102-B(1):11-16
pubmed: 31888358
Clin Orthop Relat Res. 2020 Jan;478(1):90-100
pubmed: 31855192
Acta Orthop Traumatol Turc. 2020 Jan;54(1):83-88
pubmed: 32175901
Acta Orthop. 2011 Jun;82(3):275-81
pubmed: 21561308
J Orthop Trauma. 2012 Mar;26(3):135-40
pubmed: 22198652
Clin Orthop Relat Res. 2014 Apr;472(4):1291-9
pubmed: 24081667
Medicine (Baltimore). 2020 Feb;99(8):e19039
pubmed: 32080078
Acta Orthop. 2020 Apr;91(2):133-138
pubmed: 31735103
J Bone Joint Surg Am. 2012 Apr 4;94(7):577-83
pubmed: 22488613
JAMA. 2020 Mar 17;323(11):1077-1084
pubmed: 32181848
Bone Joint J. 2017 Apr;99-B(4):421-431
pubmed: 28385929
Int Orthop. 2019 Jul;43(7):1715-1723
pubmed: 30919045
Bone Joint J. 2015 Nov;97-B(11):1475-80
pubmed: 26530648
Clin Orthop Relat Res. 2008 Oct;466(10):2513-8
pubmed: 18651200
Pak J Med Sci. 2016 Jan-Feb;32(1):44-8
pubmed: 27022343
J Arthroplasty. 2003 Apr;18(3 Suppl 1):80-1
pubmed: 12730934
Eur J Orthop Surg Traumatol. 2019 May;29(4):731-746
pubmed: 30694383
J Bone Joint Surg Br. 1991 Mar;73(2):322-4
pubmed: 2005165
J Arthroplasty. 1986;1(1):21-8
pubmed: 3559574
Sci Rep. 2017 Oct 12;7(1):13103
pubmed: 29026135
Clin Orthop Relat Res. 2009 Sep;467(9):2426-35
pubmed: 19130162
Acta Orthop Scand. 1982 Dec;53(6):953-6
pubmed: 6758474
Injury. 2006 Feb;37(2):169-74
pubmed: 16413024
Injury. 2015 Nov;46 Suppl 6:S52-6
pubmed: 26606990
Materials (Basel). 2016 Oct 06;9(10):
pubmed: 28773942
PLoS One. 2013 Jul 23;8(7):e68903
pubmed: 23935902
Eur J Orthop Surg Traumatol. 2014 Jan;24(1):7-14
pubmed: 23412274
N Engl J Med. 2022 Feb 10;386(6):521-530
pubmed: 35139272
J Tissue Viability. 2022 May;31(2):332-338
pubmed: 35086758
Br J Anaesth. 2005 Jan;94(1):24-9
pubmed: 15516350
Medicine (Baltimore). 2019 Feb;98(8):e14634
pubmed: 30813202
Bone Joint J. 2018 Aug;100-B(8):1087-1093
pubmed: 30062941
J Bone Joint Surg Br. 2010 Jan;92(1):116-22
pubmed: 20044689
Acta Orthop. 2019 Jun;90(3):270-274
pubmed: 30931662
Ann Thorac Surg. 2011 Jan;91(1):276-8
pubmed: 21172531
BMC Musculoskelet Disord. 2017 Apr 21;18(1):169
pubmed: 28431543
Orthop Nurs. 2017 May/Jun;36(3):224-228
pubmed: 28538539
Arch Osteoporos. 2013;8:136
pubmed: 24113837
Postgrad Med J. 2017 Dec;93(1106):736-742
pubmed: 28751437
Arch Orthop Trauma Surg. 2013 Jun;133(6):805-9
pubmed: 23532371