Contemporary cemented versus uncemented hemiarthroplasty for the treatment of displaced intracapsular hip fractures: a meta-analysis of forty-two thousand forty-six hips.

INTRODUCTION: Controversy exists regarding the use of cement for hemiarthroplasty to treat displaced intracapsular hip fractures. The aim of this systematic review and meta-analysis was to compare the clinical outcomes between contemporary cemented and contemporary uncemented hemiarthroplasty for the treatment of displaced femoral neck fractures. METHODS: Literature searches of PubMed, Scopus, Web of Science, and Cochrane Central, up to May 2017, were performed. We included randomized controlled trials (RCTs) and observational studies comparing contemporary cemented with contemporary uncemented hemiarthroplasty. Data were pooled as mean difference (MD) or risk ratio (RR) with 95% confidence interval (CI) in a meta-analysis model. Studies with the Thompson and Austin Moore prostheses were excluded. RESULTS: A total of 29 studies (9 RCTs and 20 observational studies), with a total of 42,046 hips, were included. Meta-analysis showed that the cemented group was associated with fewer periprosthetic fractures (RR = 0.44, 95% CI [0.21, 0.91]), longer operative time (MD = 11.25 min, 95% CI [9.85, 12.66]), more intraoperative blood loss (MD = 68.72 ml, 95% CI [50.76, 86.69]), and higher heterotopic ossification (RR = 1.79, 95% CI [1.11, 2.88]) compared with the uncemented group. Meta-analysis showed no significant difference in terms of post-operative hip function, hip pain, reoperation rate, prosthetic dislocations, aseptic loosening, wound infection, and hospital stay. CONCLUSIONS: This meta-analysis shows that contemporary cemented prostheses have less intra-operative and post-operative fractures, but longer operative time, more intra-operative blood loss, and heterotopic ossifications. Otherwise, there were no significant differences between both groups.

Correction to: Contemporary cemented versus uncemented hemiarthroplasty for the treatment of displaced intracapsular hip fractures: a meta-analysis of forty-two thousand forty-six hips.

The author name "Muhammad Shawqi" was incorrectly presented as "Muhammad Shawq".

The influence of obesity on early outcomes in primary hip arthroplasty.

Obesity is considered an independent risk factor for adverse outcome after arthroplasty surgery. Data on 191 consecutive total hip arthroplasties were prospectively collected. Body mass index (BMI) was calculated for each patient and grouped into nonobese (BMI <30 kg/m(2)), obese (BMI 30-34.9 kg/m(2)), and morbidly obese (BMI ≥35 kg/m(2)). Primary outcomes included functional improvement (Oxford hip score, 6-minute walk test and Short Form-12 Health Survey general health questionnaire) and postoperative complications. Subgroup analysis of surgeons' overall perception of operative technical difficulty was also performed. This study shows that total hip arthroplasties in obese patients were perceived, by the surgeon, to be significantly more difficult. However, this did not translate to an increased risk of complications, operation time, or blood loss, nor suboptimal implant placement. In addition, our results suggest that obese patients gain similar benefit from hip arthroplasty as do nonobese patients, but morbidly obese patients have significantly worse 6-minute walk test scores at 6 weeks.

Silent soft tissue pathology is common with a modern metal-on-metal hip arthroplasty.

BACKGROUND AND PURPOSE: Adverse reactions to metal debris have been reported to be a cause of pain in metal-on-metal hip arthroplasty. We assessed the incidence of both symptomatic and asymptomatic adverse reactions in a consecutive series of patients with a modern large-head metal-on-metal hip arthroplasty. METHODS: We studied the early clinical results and results of routine metal artifact-reduction MRI screening in a series of 79 large-head metal-on-metal hip arthroplasties (ASR; DePuy, Leeds, UK) in 68 patients. 75 hips were MRI scanned at mean 31 (12-52) months after surgery. RESULTS: 27 of 75 hips had MRI-detected metal debris-related abnormalities, of which 5 were mild, 18 moderate, and 4 severe. 8 of these hips have been revised, 6 of which were revised for an adverse reaction to metal debris, diagnosed preoperatively with MRI and confirmed histologically. The mean Oxford hip score (OHS) for the whole cohort was 21. It was mean 23 for patients with no MRI-based evidence of adverse reactions and 19 for those with adverse reactions detected by MRI. 6 of 12 patients with a best possible OHS of 12 had MRI-based evidence of an adverse reaction. INTERPRETATION: We have found a high early revision rate with a modern, large-head metal-on-metal hip arthroplasty. MRI-detected adverse rections to metal debris was common and often clinically "silent". We recommend that patients with this implant should be closely followed up and undergo routine metal artifact-reduction MRI screening.