Uncemented Hemiarthroplasty in Displaced Femoral Neck Fractures is associated with Higher Perioperative Surgical Complications but Lower Medical Complications: Analysis from the National Inpatient Database

Document Type : RESEARCH PAPER


1 Boston VA Medical Center, Boston, MA, USA

2 Orthopedic Resident, Boston Medical Center, Boston University, Boston, MA, USA

3 Paul L. Foster School of Medicine, Texas Tech Health Sciences Center,El Paso, Texas, USA

4 University of Texas Southwestern, Dallas, Texas, USA

5 Dallas VA medical center, Dallas, USA


Objectives: This study aimed to analyze and compare the perioperative outcomes of cemented and 
uncemented hemiarthroplasty in elderly patients with displaced femoral neck fractures by utilizing the 
data from the National Inpatient Sample database.
Methods: Data from the National Inpatient Sample Database was analyzed to identify patients who underwent 
hemiarthroplasty following a displaced femoral neck fracture (cemented and uncemented. Demographic data, 
comorbidities, length of stay, total charges, and perioperative complications were analyzed.
Results: 27390 patients were identified in the cemented group and 29406 in the uncemented group. The patients 
who underwent uncemented hemiarthroplasty demonstrated a higher incidence of prosthetic dislocation (Odds Ratio 
(OR) 3.348, p < 0.001), periprosthetic mechanical complications (OR 2.597, p < 0.001), wound dehiscence (OR 
2.883, p < 0.001), superficial surgical site infection (OR 2.396, p = 0.043), deep surgical site infection (OR 1.686, p 
< 0.001), and periprosthetic fractures (OR 2.292, p < 0.001) as compared with patients who underwent cemented 
hemiarthroplasty. However, patients with uncemented fixation demonstrated a lower incidence of death (OR 0.567, 
p < 0.001), pulmonary embolism (OR 0.565, p < 0.001), deep vein thrombosis (DVT) (OR 0.746, p < 0.001), 
myocardial infarction (OR 0.772, p = 0.025) and blood loss anemia (OR 0.869, p < 0.001) as compared with 
cemented fixation. 
Conclusion: Our study on displaced femoral neck fractures utilizing the National Inpatient database found that 
uncemented hemiarthroplasty was associated with a higher incidence of perioperative surgical complications. 
Cemented hemiarthroplasty, however, was associated with a statistically significant higher rate of death, pulmonary 
embolism, deep vein thrombosis, and myocardial infarction.
 Level of evidence: III


Main Subjects


    1. Deangelis JP, Ademi A, Staff I, Lewis CG. Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: a prospective randomized trial with early follow-up. J Orthop Trauma. 2012; 26(3):135-140. doi:10.1097/BOT.0b013e318238b7a5.
    2. Bhandari M, Einhorn TA, Guyatt G, et al. Total Hip Arthroplasty or Hemiarthroplasty for Hip Fracture. N Engl J Med. 2019; 381(23):2199-2208. doi: 10.1056/NEJMoa1906190.
    3. Parker MJ, Gurusamy KS, Azegami S. Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. Cochrane Database Syst Rev. 2010 ;( 6):CD001706. doi: 10.1002/14651858.CD001706.pub4.
    4. Voskuijl, Timothy; Neuhaus, Valentin; Kinaci, Ahmet; Vrahas, Mark; Ring, David. In-Hospital outcomes after hemiarthroplasty versus total hip arthroplasty for isolated femoral neck fractures. Arch Bone Jt Surg. 2014; 2(3):151-156. doi: 10.22038/ABJS.2014.3354
    5. Khan RJK, MacDowell A, Crossman P, Keene GS. Cemented or uncemented hemiarthroplasty for displaced intracapsular fractures of the hip—a systematic review. Injury. 2002; 33(1):13-17. doi: 10.1016/S0020-1383(01)00101-2.
    6. Gjertsen JE, Lie SA, Vinje T, et al. More re-operations after uncemented than cemented hemiarthroplasty used in the treatment of displaced fractures of the femoral neck: an observational study of 11,116 hemiarthroplasties from a national register. J Bone Joint Surg Br. 2012; 94(8):1113-1119. doi:10.1302/0301-620X.94B8.29155.
    7. Andersen MF, Jakobsen T, Bensen AS, Krarup N. Lower reoperation rate for cemented femoral stem than for uncemented femoral stem in primary total hip arthroplasty following a displaced femoral neck fracture. SICOT-J. 2015; 1:26. doi:10.1051/sicotj/2015028.
    8. Figved W, Opland V, Frihagen F, Jervidalo T, Madsen JE, Nordsletten L. Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures. Clin Orthop. 2009; 467(9):2426-2435. doi: 10.1007/s11999-008-0672-y.
    9. Soleimanha M, Sedighinejad A, Haghighi M, Nabi BN, Mirbolook AR, Mardani-Kivi M. Hemodynamic and Arterial Blood Gas Parameters during Cemented Hip Hemiarthroplasty in Elderly Patients. Arch Bone Jt Surg. 2014;2(3):163-7. doi: 10.22038/ABJS.2014.3232
    10. Lin FF, Chen YF, Chen B, Lin CH, Zheng K. Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: A meta-analysis of randomized controlled trails. Medicine (Baltimore). 2019; 98(8):e14634. doi:10.1097/MD.0000000000014634.
    11. Ogawa T, Yoshii T, Okawa A, Fushimi K, Jinno T. Association Between Cemented vs Cementless Hemiarthroplasty and Short-Term Change of In-Hospital Mortality in Elderly Patients with Femoral Neck Fracture: A Propensity-Score Matching Analysis in a Multicenter Database. Clin Interv Aging. 2021; 16:1151-1159. doi:10.2147/CIA.S315090.
    12. Healthcare Cost and Utilization Project (HCUP). Agency for Healthcare Research and Quality, Rockville, MD. Available at: https://www.ahrq.gov/data/hcup/index.html. Accessed December, 2022.
    13. Veldman HD, Heyligers IC, Grimm B, Boymans TAEJ. Cemented versus cementless hemiarthroplasty for a displaced fracture of the femoral neck: a systematic review and meta-analysis of current generation hip stems. Bone Jt J. 2017; 99-B (4):421-431. doi:10.1302/0301-620X.99B4.BJJ-2016-0758.R1.
    14. Fu CW, Ma HH, Liu YC, et al. Are functional outcomes and reoperation rates really better than those of cementless stems in displaced femoral neck fractures? An updated systematic review and meta-analysis of randomized controlled trials in current-generation stem designs. J Chin Med Assoc. 2021; 84(10):969-981. doi:10.1097/JCMA.0000000000000608.
    15. Li N, Zhong L, Wang C, Xu M, Li W. Cemented versus uncemented hemi-arthroplasty for femoral neck fractures in elderly patients: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). 2020; 99(8):e19039. doi:10.1097/MD.0000000000019039.
    16. Liu B, Li A, Wang J, et al. Cemented versus uncemented hemiarthroplasty for elderly patients with displaced fracture of the femoral neck: A PRISMA-compliant meta-analysis of randomized controlled trial. Medicine (Baltimore). 2020; 99(33):e21731. doi:10.1097/MD.0000000000021731.