Outcomes of Cemented versus Cementless Total Hip Arthroplasty Following Displaced Femoral Neck Fracture in Patients Under 65 Years of Age.

Abstract

Cemented femoral fixation is recommended for total hip arthroplasty (THA) performed in elderly patients who have displaced femoral neck fractures (FNFs). However, the optimal choice of femoral fixation is unknown for younger patients who have this injury. The purpose of this study was to compare outcomes of cemented versus cementless femoral fixation in THA performed in FNF patients younger than 65 years of age. We identified 139 patients under 65 years of age treated with primary THA for FNF from 1970 to 2020. Of these, 70 received cemented and 69 received cementless femoral fixation. The mean age of the entire cohort was 59 years, and 68% were women. There were six Dorr A (4%), 97 Dorr B (70%), and 16 Dorr C (13%) femora. Gray's tests were used to compare the cumulative incidence of any revision of the femoral component, any reoperation, revision for femoral component aseptic loosening, and periprosthetic femoral fracture between cemented and cementless groups, with mortality as a competing risk. The mean follow-up was 10 years. There were no differences in the 10-years cumulative incidence of any revision of the femoral component (3 versus 9%), any reoperation (10 versus 14%), or revision for femoral aseptic loosening (3 versus 2%) when comparing cemented versus cementless femoral components. The 10-years cumulative incidence of periprosthetic femoral fracture was significantly higher in the cementless cohort compared to the cemented cohort (18 versus 2%). Selective use of cementless femoral fixation in patients younger than 65 years who had an FNF did not result in increased risk of revision or reoperation at 10 years compared to cemented fixation. However, the significantly increased risk of periprosthetic fracture in cementless femora must be considered when choosing femoral fixation in this population and warrants future study.