Raja Balgovind S, Gowda Aditya K S, Singh Sukhmin, Ansari Sajid, Kalia Roop Bhushan, Paul Souvik
Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India.
Subharta Medical College, Dehradun, India.
J Clin Orthop Trauma. 2022 Apr 22;29:101876. doi: 10.1016/j.jcot.2022.101876. eCollection 2022 Jun.
The neck of femur fractures in the elderly is a global concern. These fractures impair the quality of living and add to morbidity and mortality. A Multitude of treatment options for the same. This systematic review focuses on evaluating outcomes between cemented and uncemented total hip replacement in the elderly population with neck of femur fractures.
The search was conducted in databases PubMed, Embase, Scopus, open grey, and Cochrane following PRISMA guidelines. The studies fulfilling the inclusion criteria were included, scrutinized for data analysis, and also quality appraisal of all the included studies was conducted to be included in this article.
A total of 7 studies were included (2 RCT, 5 retrospective studies) comprising 1171 THRs. Data analysis showed a higher HHS in cemented compared to uncemented(p < 0.001). The uncemented group had a significantly higher rate of revision, dislocation, and periprosthetic fracture compared to cemented group(p < 0.001). However, VAS score, loosening rates, and heterotopic ossification were similar in both statistically insignificant groups.
Choosing between cemented and uncemented techniques had been a controversy with lesser data due to higher morbidity and mortality. This systematic review provides information regarding functional outcomes and complications in both groups. The cemented group had better outcomes and lesser complications which should be preferred in elderly patients as the conclusion of this study. However, a larger RCT with better follow-up is still required.
Level I, systematic review and meta-analysis.
老年股骨颈骨折是一个全球性问题。这些骨折会损害生活质量，并增加发病率和死亡率。针对此类骨折有多种治疗选择。本系统评价聚焦于评估老年股骨颈骨折患者行骨水泥型与非骨水泥型全髋关节置换术的疗效。
按照PRISMA指南在PubMed、Embase、Scopus、Open Grey和Cochrane数据库中进行检索。纳入符合纳入标准的研究，进行数据分析，并对所有纳入研究进行质量评估以纳入本文。
共纳入7项研究（2项随机对照试验，5项回顾性研究），包含1171例全髋关节置换术。数据分析显示，骨水泥型的髋关节 Harris 评分高于非骨水泥型（p < 0.001）。与骨水泥型组相比，非骨水泥型组的翻修率、脱位率和假体周围骨折发生率显著更高（p < 0.001）。然而，两组的视觉模拟评分、松动率和异位骨化在统计学上无显著差异。
由于较高的发病率和死亡率，骨水泥型与非骨水泥型技术的选择一直存在争议且数据较少。本系统评价提供了两组功能结局和并发症的相关信息。本研究结论为，骨水泥型组疗效更好且并发症更少，老年患者应优先选择。然而，仍需要开展随访更好的大型随机对照试验。
I级，系统评价和荟萃分析。
