JOA - 2026-06-15 - Journal Article
A Contemporary Comparison of Modern Cementless to Cemented Femoral Stems for Treatment of Femoral Neck Fractures.
Chen XT, Springer BD, Borkar S, Porter SB, Spaulding A, Trousdale RT, Goulding KA, Wilke BK
Topics
Key Takeaway
When collared cemented stems are compared to metaphyseal-filling collared cementless stems via propensity matching, periprosthetic fracture rates (3% vs 2%) and BCIS rates are statistically equivalent across 213 matched pairs.
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Summary
This multi-institutional retrospective study compared cemented versus cementless femoral fixation in 2,829 THA/HA patients treated for femoral neck fractures between 2017 and 2024, using propensity matching to control for age, sex, BMI, and comorbidities. In the broad fixation comparison (346 matched pairs), cemented fixation had fewer periprosthetic fractures (4% vs 7%, P=0.04) but more Grade 1 BCIS (43% vs 32%, P<0.01). When the comparison was restricted to collared cemented versus metaphyseal-filling collared cementless stems (213 matched pairs), no differences were found in periprosthetic fracture, BCIS, mortality, DVT, or SSI.
Key Limitation
The cementless cohort was significantly younger (75 vs 83 years) with a higher proportion of men prior to matching, and residual confounding from unmeasured variables such as bone quality, surgeon volume, and anesthesia type cannot be excluded in a retrospective design.
Original Abstract
INTRODUCTION
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.
METHODS
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.
RESULTS
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.
CONCLUSION
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.