Cemented hemiarthroplasty improves quality of life for intracapsular hip fracture patients

1. In patients with an intracapsular hip fracture, cemented hemiarthroplasty resulted in a significantly better quality of life than uncemented hemiarthroplasty.

2. In patients with an intracapsular hip fracture, cemented hemiarthroplasty led to a significantly lower risk of periprosthetic fracture than uncemented hemiarthroplasty.

Evidence Rating Level: 1 (Excellent)

Study Rundown: The incidence of hip fractures is projected to reach 6.26 million per year by 2050. Currently, half of all hip fractures are treated with a partial hip replacement in which the femur head is replaced with a metal implant, called a hemiarthroplasty. However, there is a gap in knowledge as to understanding whether fixing the hemiarthroplasty with cement, which can lead to significant adverse effects but has been hypothesized to have better mobility, leads to higher health-related quality of life. This study found that in adults 60 years or older, those with an intracapsular hip fracture who underwent cemented hemiarthroplasty had a significantly higher quality of life compared to those who received modern uncemented hemiarthroplasty. This study was limited by the high frequency of missing baseline data and attrition in the older and frail patient group. Nevertheless, the study’s findings are significant, as they demonstrate that cemented hemiarthroplasty led to a significantly better quality of life and lower risk of periprosthetic fracture compared to uncemented hemiarthroplasty in patients 60 years or older with a displaced intracapsular hip fracture.

Click to read the study in NEJM

Relevant Reading: How to Fill the Void — Bone Cement in Hemiarthroplasty

In-Depth [randomized control trial]:  This multicenter, randomized control superiority trial compared cemented with uncemented hemiarthroplasty in patients 60 years or older with a displaced intracapsular hip fracture. A total of 610 patients were assigned to undergo cemented hemiarthroplasty and 615 were assigned to undergo uncemented hemiarthroplasty. Patients who were 60 years or older with a displaced intracapsular hip fracture were eligible for the study. Patients who did not meet these qualifications or were unable or unwilling to provide consent were excluded from the study. The primary outcome measured was health-related quality of life measured with utility scores on the EuroQol Group 5-Dimension (EQ-5D) questionnaire at 4 months after randomization, with higher scores indicating better quality of life. Outcomes in the primary analysis were assessed via linear regression analysis and longitudinal mixed-effects model. Between the two groups, the mean EQ-5D utility score was 0.371 in the cemented group and 0.315 in the uncemented group (95% confidence interval [CI], 0.009 to 0.101). In the cemented group, mortality was 23.9% at 12 months and 27.8% for those in the uncemented group (95% CI, 0.62 to 1.05). Additionally, periprosthetic fracture rates were 0.5% in the cemented group and 2.1% in the uncemented group (95% CI, 1.19 to 24.00). Overall, this study demonstrates that treatment of intracapsular hip fractures in patients over 60 years of age with cemented hemiarthroplasty provides significantly better health-related quality of life, lower mortality rates, and lower risk of periprosthetic fractures compared to an uncemented hemiarthroplasty.

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