Fri., 10/15/10 Geriatrics, Paper #43, 10:29 am OTA-2010
Functional Status, Morbidity and Mortality in Cemented versus Press-Fit Hemiarthroplasty for Displaced Femoral Neck Fractures: A Prospective Randomized Trial
Joseph P. DeAngelis, MD1; Arben Ademi, BA2; Courtland G. Lewis, MD2;
1Beth Israel Deaconess Medical Center/Harvard Medical School - Orthopaedics,
Boston, Massachusetts, USA;
2Hartford Hospital, University of Connecticut, Hartford, Connecticut, USA
Purpose: This study was conducted to compare prospectively the morbidity, mortality, and functional outcome associated with cemented and press-fit hemiarthroplasty for displaced femoral neck fractures.
Hypothesis: The use of press-fit hemiarthroplasty in the treatment of displaced subcapital fractures of the femoral neck would be associated with a decreased risk of adverse perioperative outcomes, and that the functional results of cemented and press-fit hemiarthroplasty would be equivalent at 1 year.
Methods: In a prospective, randomized trial, patients 55 years of age and older with a nonpathologic, displaced femoral neck fracture were randomly assigned to treatment with a cemented (66 patients) or a press-fit (64 patients) femoral implant and a unipolar head.
Results: No statistically significant differences were present in the groups’ preoperative or intraoperative characteristics, including American Society of Anesthesiologists (ASA) grade, operative time, anesthesia time, use of perioperative beta blockers, estimated blood loss, or the rate of intraoperative fracture. Postoperatively, no difference was found in hemoglobin level, transfusion rate, discharge disposition, or acute complication rate. At 30-day, 60-day, and 1-year follow-up, no clinically or statistically significant differences were found in mortality, disposition, need for assistance with ambulation, Older Americans Resources & Services (OARS) Activities of Daily Living subscales, or the energy/fatigue (EF) scale.
Conclusions: In the treatment of nonpathologic, displaced femoral neck fractures, the use of press-fit and cemented femoral components is associated with similar mortality, morbidity, and functional outcome at 1 year. Practitioners may inform their clinical decisions using these equally good results.
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• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.