Arthroplasties (with and without bone cement) for proximal femoral fractures in adults
Abstract
Background
Numerous types of arthroplasties may be used in the surgical treatment of a hip fracture (proximal femoral fracture). The main differences between the implants are the design of the stems, whether the stem is fixed in place with or without cement, whether a second articulating joint is included within the prosthesis (bipolar prosthesis) or whether the whole hip joint is replaced.
Objectives
To review all randomised trials that have compared different arthroplasties for the treatment of hip fractures in adults.
Search methods
We searched the Cochrane Musculoskeletal Injuries Group specialised register. Additional trials were identified by searching reference lists of relevant articles, conference proceedings, and contact with trialists. Date of most recent search: January 2001.
Selection criteria
All randomised and quasi‐randomised trials comparing different arthroplasties (and or cement), for the treatment of hip fractures.
Data collection and analysis
Two reviewers independently assessed trial quality, by use of a ten‐item checklist and extracted data.
Main results
Thirteen trials involving 1464 patients were included. One trial investigated two comparisons. Cemented prostheses, when compared with uncemented (four trials, 391 participants) were associated with a lower risk of failure to regain mobility (relative risk (RR) 0.60, 95% confidence interval (CI) 0.44, 0.82) and of post‐operation pain at a year or later (RR 0.51, 95% CI 0.31, 0.81). For this comparison, there were no significant differences in any other outcome. Comparison of unipolar hemiarthroplasty with bipolar hemiarthroplasty (six trials, 742 participants) showed no significant differences between the two types of implant. Two trials of 269 patients compared different types of hemiarthroplasty with a total hip replacement and two trials of 151 patients compared either different types of prosthesis head or different bipolar prostheses. Because of the limited number of cases and the use of different prostheses, no definite conclusions could be made from these four studies.
Authors' conclusions
Cementing prostheses in place seems to reduce pain post‐operatively and results in better mobility, but because of the under‐reporting of outcomes and the small number of patients involved, no definite conclusions can be made. The role of bipolar prostheses and total hip replacement is uncertain. Further well‐conducted randomised trials are required.
Plain language summary
Not enough evidence to show which artificial hip joint is best for a hip fracture
Many different types of artificial hip joints (arthroplasties) may be used for a break in the bone near the hip joint (hip fracture). There is not enough evidence from trials to show which arthroplasty is best. There is limited evidence that people with arthroplasties that are cemented in place may have less pain and more mobility after the operation than those which are inserted as a press fit, but more research is needed.
