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Cemented or uncemented hemiarthroplasty for intracapsular hip fracture
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Fernandez, Miguel A., Achten, Juul, Parsons, Nicholas R., Griffin, Xavier L., Png, May-Ee, Gould, Jenny, McGibbon, Alwin and Costa, Matthew L. (2022) Cemented or uncemented hemiarthroplasty for intracapsular hip fracture. New England Journal Of Medicine, 386 (6). pp. 521-530. doi:10.1056/nejmoa2108337 ISSN 0028-4793.
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Official URL: https://doi.org/10.1056/nejmoa2108337
Abstract
Background:
Controversy exists over the use of bone cement in hip fractures treated with hemiarthroplasty. Only limited data on quality of life after cemented as compared with modern uncemented hemiarthroplasties are available.
Methods:
We conducted a multicenter, randomized, controlled trial comparing cemented with uncemented hemiarthroplasty in patients 60 years of age or older with an intracapsular hip fracture. The primary outcome was health-related quality of life measured with the use of utility scores on the EuroQol Group 5-Dimension (EQ-5D) questionnaire at 4 months after randomization (range of scores, −0.594 to 1, with higher scores indicating better quality of life; range for minimal clinically important difference, 0.050 to 0.075).
Results:
A total of 610 patients were assigned to undergo cemented hemiarthroplasty and 615 to undergo modern uncemented hemiarthroplasty; follow-up data were available for 71.6% of the patients at 4 months. The mean EQ-5D utility score was 0.371 in patients assigned to the cemented group and 0.315 in those assigned to the uncemented group (adjusted difference, 0.055; 95% confidence interval [CI], 0.009 to 0.101; P=0.02). The between-group difference at 1 month was similar to that at 4 months, but the difference at 12 months was smaller than that at 4 months. Mortality at 12 months was 23.9% in the cemented group and 27.8% in the uncemented group (odds ratio for death, 0.80; 95% CI, 0.62 to 1.05). Periprosthetic fractures occurred in 0.5% and 2.1% of the patients in the respective groups (odds ratio [uncemented vs. cemented], 4.37; 95% CI, 1.19 to 24.00). The incidences of other complications were similar in the two groups.
Conclusions:
Among patients 60 years of age or older with an intracapsular hip fracture, cemented hemiarthroplasty resulted in a modestly but significantly better quality of life and a lower risk of periprosthetic fracture than uncemented hemiarthroplasty. (Funded by the National Institute for Health Research; WHiTE 5 ISRCTN number, ISRCTN18393176. opens in new tab.)
| Item Type: | Journal Article | |||||||||
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| Subjects: | R Medicine > RA Public aspects of medicine R Medicine > RD Surgery |
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| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Statistics and Epidemiology Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| SWORD Depositor: | Library Publications Router | |||||||||
| Library of Congress Subject Headings (LCSH): | Hip joint -- Fractures, Hip joint -- Fractures -- Treatment, Bone cements , Fractures in old age -- Treatment | |||||||||
| Journal or Publication Title: | New England Journal Of Medicine | |||||||||
| Publisher: | Massachusetts Medical Society | |||||||||
| ISSN: | 0028-4793 | |||||||||
| Official Date: | 10 February 2022 | |||||||||
| Dates: |
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| Volume: | 386 | |||||||||
| Number: | 6 | |||||||||
| Page Range: | pp. 521-530 | |||||||||
| DOI: | 10.1056/nejmoa2108337 | |||||||||
| Status: | Peer Reviewed | |||||||||
| Publication Status: | Published | |||||||||
| Reuse Statement (publisher, data, author rights): | From New England Journal Of Medicine, 386 (6). pp. 521-530. Copyright © 2022 Massachusetts Medical Society. Reprinted with permission. | |||||||||
| Access rights to Published version: | Restricted or Subscription Access | |||||||||
| Date of first compliant deposit: | 3 March 2022 | |||||||||
| Date of first compliant Open Access: | 10 August 2022 | |||||||||
| RIOXX Funder/Project Grant: |
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