Long-term outcomes of cemented compared to uncemented femoral stems in total hip arthroplasty for displaced femoral neck fractures in elderly patients.

Background: Total hip replacement (THR) is commonly used for active and lucid elderly patients with displaced femoral neck fractures (FNF). Historically, cemented stems have been favoured, demonstrating superior early outcomes. Controversy still exists regarding the use of cemented or uncemented stems in the most active group of patients with FNF and there is a need for extended follow-up studies to assess long-term outcome of cemented and uncemented stem results.

Methods: A 4 and 10-year follow-up was conducted on a single-centre, single-blinded, randomized controlled trial. Patients aged 65-79 years with an acute displaced FNF (Garden III-IV) were included, and surgeries were performed between 2009 and 2014. The study was terminated after an interim analysis indicated that the total number of early hip-related complications was substantially higher in the uncemented group. Baseline and follow-up assessments included hip-related complications, reoperations, health-related quality of life scores, Harris hip score and pain ratings.

Results: In total, 69 patients were randomized. At 4 years, there were 8 complications in the uncemented group and 2 complications in the cemented groups. The uncemented group had several periprosthetic fractures and dislocations necessitating revisions in several cases. From 4 to 10 years, the cemented group showed a single periprosthetic fracture, while none occurred in the uncemented group. The total number of complications during the study period were 8 in the uncemented group and 3 in the cemented group. The median Harris hip score for the uncemented group remained consistent at 81 for both the 4- and 10-year follow-ups. In contrast, the cemented group showed scores of 92 and 93 at the respective 4- and 10-year follow-ups, with no statistically significant difference between the two groups. Health-related quality of life and pain ratings were similar between groups throughout the study.

Conclusion: Our study presents a 10-year follow-up of uncemented femoral stems in THR for elderly FNF patients. Our findings not only underscore the importance of cautious decision-making in selecting patients for uncemented implants, but also highlight that most patients suitable for THR would benefit from a cemented arthroplasty to avoid an increased risk of short-term complications.