October 24, 2013Clinical Orthopaedics and Related Research
Cochrane in CORR ®: Arthroplasties (With and Without Bone Cement) For Proximal Femoral Fractures in Adults
Key result
Cemented implants were found to reduce pain and increase mobility compared to noncemented implants in elderly patients with displaced femoral neck fractures.
Why the study?
Do different arthroplasty approaches (e.g., cemented vs noncemented, THR vs hemiarthroplasty) improve functional outcomes and reduce complications in adults with displaced femoral neck fractures?
Population
Adults with proximal femoral fractures
Comparison
Various arthroplasties vs Alternative arthroplasty approaches
Design
Review
Authors
Discussion
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Implication
May support cemented implants for pain and mobility; leaves open confirmation in large, rigorous RCTs before practice change.
Structured PICO
Do different arthroplasty approaches (e.g., cemented vs noncemented, THR vs hemiarthroplasty) improve functional outcomes and reduce complications in adults with displaced femoral neck fractures?
P
Population
Adults with displaced femoral neck fractures undergoing arthroplasty.
I
Intervention
Various arthroplasties (including total hip replacement, hemiarthroplasty, cemented implants, bipolar implants)
C
Comparator
Alternative arthroplasty approaches (e.g., noncemented implants, unipolar hemiarthroplasty)
O
Outcome
Patient-important functional outcomes (pain, walking ability, health-related quality of life) and medical complications/mortalitypatient reported
While cemented implants appear to improve pain and mobility over noncemented ones for femoral neck fractures, the overall evidence base is limited by small, methodologically flawed trials, highlighting the need for large, rigorous RCTs.
Limitations
- Numerous methodological weaknesses in the primary articles
- Many summary estimates based on only a few studies
- More than half of the included trials had sample sizes of fewer than 100 patients
- Only 12 trials used an appropriate method of randomization
- Outcome assessors were blinded in only two trials
- Two-thirds of the trials failed to achieve 2-years of minimum followup
- Few trials performed an intention-to-treat analysis
- Numerous methodological weaknesses in primary articles
- Small sample sizes (more than half of trials <100 patients)
- Only 12 trials used appropriate randomization
- Outcome assessors blinded in only two trials
- Two-thirds of trials failed to achieve 2-years minimum followup
Cite This Study
Evaniew et al. (2013) conducted an editorial in Proximal femoral fractures. Cemented arthroplasty vs. Noncemented arthroplasty was evaluated. Cemented implants were found to reduce pain and increase mobility compared to noncemented implants in elderly patients with displaced femoral neck fractures.