A Contemporary Comparison of Modern Cementless to Cemented Femoral Stems for Treatment of Femoral Neck Fractures.

Abstract

Cemented femoral fixation is considered the gold standard in total hip arthroplasty (THA) and hemiarthroplasty (HA) for femoral neck fractures (FNF), given lower periprosthetic fracture risk compared to cementless fixation. However, one major concern with cementation is bone-cement implantation syndrome (BCIS), a phenomenon involving cardiopulmonary distress attributed to cement pressurization. This study compared outcomes based on fixation method and stem design and evaluated the utilization of cemented versus cementless fixation following FNF. A retrospective review identified 2,829 patients who underwent THA or HA for FNF between December 2017 and January 2024 within a multi-institutional hospital enterprise. Cementless fixation was performed in 598 patients (21%), who were younger (75 versus 83 years; P < 0.001) and more likely men (66 versus 56%; P < 0.001) than those who received cemented fixation. Patients were propensity-matched for age, sex, body mass index, and comorbidities to compare fixation type and stem design. Following propensity matching, 346 matched pairs were analyzed. Outcomes including BCIS, periprosthetic fracture, and mortality were compared using Fisher's exact tests and a conditional logistic regression model. Cemented fixation was associated with fewer periprosthetic fractures (4 versus 7%; P < 0.04), but more Grade 1 BCIS (43 versus 32%; P < 0.01). A separate propensity match was performed comparing collared cemented stems to metaphyseal filling and collared cementless implants, resulting in 213 matched pairs. There were no differences in BCIS (P < 0.56), periprosthetic fracture (3 versus 2%; P < 0.75), mortality (all P > 0.05), deep vein thrombosis (DVT), or surgical site infection (SSI) between cohorts. Vital sign abnormalities consistent with BCIS, observed in both fixation cohorts, were primarily low-grade and clinically inconsequential. Surgeons should remain vigilant for development of BCIS, but results from this study suggest that fears over morbidity and mortality due to cementation should not discourage the usage of cemented femoral fixation.