Cemented versus uncemented

hemiarthroplasty for intracapsular hip

fractures
A RANDOMISED CONTROLLED TRIAL IN 400 PATIENTS

M. I. Parker, We undertook a prospective randomised controlled trial involving 400 patients with a
G. Pryor, displaced intracapsular fracture of the hip to determine whether there was any difference in
K. Gurusamy outcome between treatment with a cemented Thompson hemiarthroplasty and an
uncemented Austin-Moore prosthesis. The surviving patients were followed up for between
From Peterborough two and five years by a nurse blinded to the type of prosthesis used.
and Stamford The mean age of the patients was 83 years (61 to 104) and 308 (77%) were women. The
Hospital NHS Trust, degree of residual pain was less in those treated with a cemented prosthesis (p < 0.0001)
Peterborough, three months after surgery. Regaining mobility was better in those treated with a cemented
England implant (p = 0.005) at six months after operation. No statistically significant difference was
found between the two groups with regard to mortality, implant-related complications,
re-operations or post-operative medical complications.
The use of a cemented Thompson hemiarthroplasty resulted in less pain and less
deterioration in mobility than an uncemented Austin-Moore prosthesis with no increase in
complications.

„ M. I. Parker, MD, FRCS(Edin),
Orthopaedic Research Fellow
„ G. Pryor, MS, FRCS,
Orthopaedic Surgeon
Orthopaedic Department
Peterborough and Stamford
Hospital NHS Foundation Trust,
Thorpe Road, Peterborough
PE3 6DA, UK.
„ K. Gurusamy, MS, MRCS,
Clinical Research Fellow
University Department of
Surgery
Royal Free Hospital, Pond
Street, London NW3 2QG, UK.
Correspondence should be sent
to Dr M. J. Parker; e-mail:
Martyn.Parker@pbh-tr.nhs.uk
©2010 British Editorial Society
of Bone and Joint Surgery
doi:10.1302/0301-620X.92B1.
22753 $2.00
J Bone Joint Surg [Br]
2010;92-B:116-22.
Received 27 April 2009;
Accepted after revision 27
August 2009
Displaced intracapsular fractures of the neck
of the femur are commonly treated by hemi-
arthroplasty. Orthopaedic surgeons are divided
as to the relative merits of cemented versus
uncemented prostheses in these patients.
Cementing the prosthesis provides more secure
fixation and may result in less residual pain and
better function. However, the insertion of
cement complicates the operation and carries
the risk of cardiovascular collapse when the
cement is introduced into the femur.1 So far, six
small randomised controlled trials involving
549 patients have been summarised in a
Cochrane Review on this subject. This
reported that patients with cemented prosthe-
ses have less pain and a tendency to better
mobility than those with uncemented prosthe-
ses.1 The authors concluded that there was lim-
ited evidence that cementing a prosthesis in
place may reduce post-operative pain and lead
to better mobility. They highlighted the need
for further well-conducted randomised con-
trolled trials.
The two most common types of hemiarthro-
plasty used for the treatment of a displaced
intracapsular fracture in the United Kingdom
are the uncemented Austin-Moore prosthesis
and the cemented Thompson hemiarthro-
plasty.2 The continued use of a mixture of
uncemented and cemented prostheses reflects
uncertainty as to the relative advantages and
disadvantages of using bone cement. We there-
fore undertook a large randomised controlled
trial comparing an uncemented Austin-Moore
prosthesis with a cemented Thompson hemi-
arthroplasty in patients with a displaced intra-
capsular fracture of the proximal femur, with a
minimum follow-up of two years’.
Materials and Methods
All patients presenting to our institution with a
displaced intracapsular fracture of the proxi-
mal femur were considered for inclusion in the
study. Patients with senile dementia were
included with the consent of their next of kin.
The inclusion and exclusion criteria are listed
in Table I. All patients with an undisplaced or
minimally displaced intracapsular fracture
were excluded from the study and treated by
internal fixation, as were all patients aged less
than 60 years with a displaced fracture and
those aged between 60 and 75 years in whom
there was no impairment of mobility (defined
as the ability to walk out of the house unaided)
immediately prior to the injury.
The study had ethical approval and the sup-
port of the hospital research and development
committee. Patients were randomised by the
opening of a sealed opaque numbered enve-
lope, prepared by a person independent of the

116 THE JOURNAL OF BONE AND JOINT SURGERY

 CEMENTED VERSUS UNCEMENTED HEMIARTHROPLASTY FOR INTRACAPSULAR HIP FRACTURES 117

Table I. Inclusion and exclusion criteria for participants in the study

Inclusion criteria
Displaced intracapsular fracture in a patient aged over 60

Exclusion criteria
Undisplaced or minimally displaced intracapsular fracture
Patients aged less than 60
Patients aged 60 to 75 years with no restriction in mobility at the time of injury
Patients who declined to participate
Patients with senile dementia for whom the assent of their next of kin was not obtained
Patients with a pathological fracture from a tumour or Paget’s disease of bone
Previous treatment to the same hip for a fracture
Patients who were not considered to be fit for either of the surgical procedures
Patients with significant arthritis of the hip that necessitated treatment with a total hip replacement
Patients admitted when the lead trialist was not available to supervise the surgical procedure

study, containing details of the procedure to be undertaken.
After randomisation all patients had to stay in the group to
which they had been allotted, regardless of any deviations
from the treatment protocol, and all results were analysed
on an intention-to-treat basis. All operations were per-
formed or supervised by one orthopaedic surgeon (MIP)
and all by a standard anterolateral approach with repair of
the joint capsule. The Austin-Moore prosthesis used
(Stryker/Howmedica Ltd, Newbury, United Kingdom) was
generally of the standard size, but if the femur was slender,
a narrow-stem implant was used. The Thompson hemi-
arthroplasty (Corin Ltd, Cirencester, United Kingdom) was
inserted after the femur had been prepared by reaming and
saline irrigation. A Hardinge cement restrictor was used
and Palacos bone cement with gentamicin (Schering-Plough
Ltd, Welwyn Garden City, United Kingdom) was inserted in
a retrograde manner into the femur using a cement gun. All
patients received peri-operative antibiotic prophylaxis and
14 days of low molecular weight heparin as thrombo-
embolic prophylaxis. After surgery all patients were mobi-
lised as soon as they were able, with no restrictions on hip
movements or weight-bearing. They were discharged home
as soon as their general condition allowed.
Patients were initially reviewed six weeks after discharge.
Subsequent assessments were by telephone at three, six,
nine and 12 months, and thereafter every year for up to five
years. All assessments were undertaken by a nurse who was
blinded to the treatment undertaken. For those patients
who could not be contacted, enquiry was made via their
next of kin or their registered medical practitioner. Finally,
if the patient could not be contacted, enquiry was made to
the Office of Population Census Service. All surviving
patients had a mean follow-up of 3.7 years (2 to 5). Three
patients were lost to follow-up, two after four years and
one after three years.
On admission the patient’s mental state was assessed
using a ten-point mental test score and their physical state
by the American Society of Anaesthesiologists (ASA)
score.3,4 Residential status was defined as living in their
own home (including warden-controlled accommodation),
Table II. Mobility assessment tool
1. Could they get about the house?
2. Was the patient able to get out of the house?
3. Could they do their shopping?
For each of the three questions:
Without any difficulty - score 3
On their own with an aid - score 2
Only with someone else’s help - score 1
Not at all. Bed or chair bound - score 0
residential care (partial care within an institution) or nurs-
ing care (full nursing care or hospital in-patient). For the
follow-up assessments, pain was assessed using a visual
analogue scale of one to ten at the outpatient clinic visit,
with least pain scoring one, and also using a scale of one to
six in which one was no pain; two occasional and slight
pain; three pain when starting walking but then getting bet-
ter with occasional analgesia; four with no or little pain at
rest, pain with activities, frequent mild analgesia; five con-
stant but bearable pain, stronger analgesia used occasion-
ally; and six constant pain with frequent strong analgesia.5
The one to six assessment scale was used for telephone
follow-up assessments. The patient’s walking ability imme-
diately prior to the fall was assessed using a mobility scale
of 0 to nine,6,7 where nine represented full mobility indoors
and outdoors without walking aids and 0 defined a bed-
bound patient (Table II). At each follow-up assessment the
time until 16 activities of daily living were regained was
also assessed.
Before commencing the study a power calculation was
undertaken using the primary outcome of degree of residual
pain at one year. The calculation was based on reducing the
number of patients with a pain score of ≥ 3 by 10%. Allow-
ing for deaths and loss to follow-up, it was estimated that
200 patients were required in each group.
Statistical analysis. Binary outcomes for the two groups
were analysed using Fisher’s exact test, and continuous out-
comes with the Mann-Whitney U test. Survival outcomes

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118 M. I. PARKER, G. PRYOR, K. GURUSAMY
1100 patients admitted with an intracapsular hip fracture
between March 2001 and November 2006
Randomised (400)
Allocated to cemented hemiarthroplasty (200)
Treated as per protocol (189)
Had internal fixation (4)
Prosthesis not cemented (4)
Cemented bipolar hemiarthroplasty used (1)
Trochanteric fracture treated (1)
Pathological fracture (1)
Completed follow-up (74)
Died during follow-up period (125)
Lost to follow-up (1)
Fig. 1
Participant flow diagram.* Patients may have been excluded for more than one reason.
were calculated using the Kaplan-Meier method, and
comparison between the groups was performed using the
Kaplan-Meier log-rank test.8 A p-value of < 0.05 was con-
sidered statistically significant.
Results
Patients were recruited over a five-year period. The rea-
sons for 700 patients not being included in the study are
shown in Figure 1. Among the 400 randomised patients,
11 in the cemented group did not have treatment as
defined in the study protocol. Five patients were consid-
ered to be unfit for a cemented hemiarthroplasty immedi-
ately prior to or during surgery, having previously been
considered fit for both procedures. Four of these were
treated by reduction and internal fixation, and one had
an uncemented Austin-Moore hemiarthroplasty. Four
patients were found to have a femur that was too narrow
to accommodate a Thompson prosthesis. Three were
treated with an uncemented narrow-stem Austin-Moore
and one with a cemented bipolar hemiarthroplasty. One
patient was found at the time of surgery to have a trochan-
teric fracture and not an intracapsular fracture, but was
still treated with a cemented Thompson hemiarthroplasty,
and one further patient was later found to have a patho-
logical fracture from a secondary tumour. A further
Excluded for not meeting inclusion criteria * (700)
Undisplaced/minimally displaced (281)
Patient too young/fit (104)
Pathological fracture (17)
No consent (9)
Treated conservatively (17)
Unfit for hemiarthroplasty (35)
Lead trialists not available (268)
Other reason (12)
Allocated to uncemented hemiarthroplasty (200)
Treated as per protocol (189)
Had internal fixation (2)
Prosthesis cemented (7)
Pathological fracture (2)
Completed follow-up (79)
Died during follow-up period (119)
Lost to follow-up (2)
11 patients in the uncemented group did not have treat-
ment as defined in the study protocol. Seven were felt to
have a prosthesis that was loose at the time of surgery,
either because of a large femoral cavity or from an opera-
tive fracture of the femur, and the prosthesis was therefore
cemented in place. Two patients, initially considered fit
for hemiarthroplasty, were considered unfit at the time of
surgery and treated by reduction and internal fixation. A
further two patients were later found to have a patho-
logical fracture secondary to a tumour.
Patient characteristics. The characteristics of the two groups
of patients are detailed in Table III. None of the differences
between the two groups was statistically significant.
Operative details. The operative details and total hospital
stay for the two groups are shown in Table IV. The mean
duration of surgery was approximately seven minutes lon-
ger for those who had a cemented prosthesis. There were no
differences in requirements for blood transfusion related to
the type of procedure. The total hospital stay was the time
spent on the orthopaedic and any other wards, including
medical and rehabilitation wards, until discharge from hos-
pital. The readmissions included were only those for condi-
tions directly related to the hip fracture. Total hospital stay
was found to be four days shorter for those treated with a
cemented prosthesis.
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 CEMENTED VERSUS UNCEMENTED HEMIARTHROPLASTY FOR INTRACAPSULAR HIP FRACTURES 119

Table III. Characteristics of patients

Cemented Thompson Uncemented Moore

Number of patients 200 200
Mean age (range) 83 (61 to 97) 83 (62 to 104)
Male (%) 39 (20) 53 (27)
From own home (%) 147 (74) 145 (73)
Mean mobility score 5.7 5.9
Mean mental test score 5.8 5.9
Mean ASA* grade 2.7 2.7
Mean haemoglobin on admission (g/l) 128 126
* ASA, American society of anaesthesiologists

Table IV. Operative details and hospital stay

Cemented Thompson Uncemented Moore p-value*

Spinal anaesthesia (%) 113 (57) 112 (56) 1.0
General anaesthesia (%) 83 (42) 85 (43) 1.0
Local anaesthesia (%) 4 (2) 3 (2) 1.0
Mean duration of surgery in mins (SD) 55.4 (13.4) 48.5 (13.2) < 0.0001
Mean duration of anaesthesia in mins (SD) 67.5 (13.5) 60.1 (13.3) < 0.0001
Required blood transfusion (%) 35 (18) 25 (13) 0.20
Mean units transfused (SD) 0.39 (0.87) 0.27 (0.72) 0.32
Operative fracture of the femur 0 14 < 0.0001
Retained cement in acetabulum 2 0 0.50
Orthopaedic ward stay in days (SD) 16.1 (14.2) 17.1 (12.4) 0.028
Initial total hospital stay in days (SD) 18.8 (21.4) 22.6 (23.5) 0.006
Hospital stay and readmissions in days (SD) 20.3 (22.3) 24.7 (25.8) 0.004
* calculated with the Mann-Whitney U and Fisher’s exact tests

Table V. General complications encountered

Cemented Thompson Uncemented Moore p-value*

Confusion 2 2 1.0
Pneumonia 1 9 0.02
Pressure sores 5 12 0.07
Deep-vein thrombosis 2 2 1.0
Pulmonary embolism 2 0 0.5
Cerebrovascular accident 2 1 1.0
Gastrointestinal bleed 4 0 0.12
Cardiac failure 4 6 0.75
Acute renal failure 0 1 1.0
Myocardial infarction 1 2 1.0
Acute cardiac arrhythmia 0 1 1.0
Acute confusion state 2 2 1.0
Intestinal obstruction 0 1 1.0
Clostridia diarrhoea 0 1 1.0
Peritonitis 1 0 1.0
* calculated with Fisher’s exact tests

In the uncemented group there were 14 intraoperative
femoral fractures. Of these, six had the Austin-Moore
cemented in place during the procedure, and one had a revi-
sion a few days later, when the implant was converted to a
cemented prosthesis. For the remaining patients the fractures
were considered not to require any change in treatment and
were managed with the standard mobilisation regimen. In
the cemented hemiarthroplasty group, two patients had
cement retained in the acetabulum which was only seen on
the post-operative radiograph. No further treatment was
necessary for this. In addition to the details given in Table IV,
one patient had a cardiac arrest on the operating table after
insertion of the cement. The patient however made an
uneventful recovery.
General complications. The general medical complications
are listed in Table V. There were no statistically significant

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120 M. I. PARKER, G. PRYOR, K. GURUSAMY

Table VI. Wound healing complications and later complications related to surgery

Cemented Thompson Uncemented Moore p-value*

Wound haematoma 2 1 1.0
Superficial wound infection 4 3 1.0
Deep wound infection 6 5 1.0
Dislocation 2 1 1.0
Drainage of infection or haematoma 3 4 1.0
Internal fixation revised to hemiarthroplasty 1 2 1.0
Revision arthroplasty for periprosthetic fracture 0 3 0.25
Revision for pain to THR† 3 7 0.34
Revision for dislocation to THR 1 1 1.0
Girdlestone arthroplasty 1 1 1.0
Girdlestone arthroplasty and later THR 2 0 0.5
Any re-operation 11 18 0.25
* calculated with Fisher’s exact tests
† THR, total hip replacement

differences between the two groups apart from an increased 1

incidence of pneumonia in those treated with an uncemented Cemented p = 0.776
prosthesis. Cumulative survival (%) hemiarthroplasty
Uncemented
Wound healing and implant-related complications. Later 0.8
hemiarthroplasty
implant-related complications are listed in Table VI. Three
of the six patients who were considered unfit for hemi-
arthroplasty at the time of surgery and were therefore 0.6
treated by reduction and internal fixation, developed non-
union and had the fixation revised to a hemiarthroplasty. 0.4
The other revisions to hemiarthroplasty or total hip
replacement were all for pain in the hip caused by either
loosening of the prosthesis or acetabular wear. In total 21 0.2
further anaesthetics were required in 11 patients in the
cemented group compared to 21 further anaesthetics in 18
0
patients in the uncemented group.
Mortality. The mortality at one year for the cemented prosthesis 0 12 24 36 48 60
was 25% and for the uncemented was 28% (Fig. 2). At no time Time (mths)
was there any statistically significant difference between the
Fig. 2
groups.
Residual pain. The mean degree of residual pain for the Survival curve showing mortality related to the type of procedure.
patients assessed is shown in Table VII and Figure 3. The
group of patients treated by the cemented prosthesis had
lower pain scores, signifying less pain, for all the assessments,
although only the results on the visual analogue scale, at eight out of a car (mean 9.1 weeks vs 15.9 weeks (p = 0.006)
weeks and at three, six, 12 and 24 months by telephone assess- and the ability to go shopping without assistance (mean
ment were statistically significant. 16.6 weeks vs 27.0 weeks, p = 0.0002).
Mobility. The differences between the admission mobility Return home. Of the 200 patients 173 (86%) treated with
score and that at each of the post-operative follow-up a cemented implant compared to 164 of 200 patients
assessments are shown in Table VIII. The scores were all (82%) with an uncemented implant returned to their orig-
lower for the cemented prosthesis, signifying that patients inal residence after their initial hospital stay (p = 0.27). A
so treated regained a better degree of mobility. total of 13 patients (7%) treated with an uncemented
Activities of daily living. There was no statistically signifi- prosthesis were unable to be discharged to their original
cant difference between the two groups for the 16 activi- residence or required a more dependent residential status
ties assessed, except for three in which function was (p = 0.121). The remaining patients died in hospital. Of
regained more rapidly in those treated by cemented the surviving patients one year after injury, 126 of 143
arthroplasty. These activities were the ability to bend (88%) in the cemented group were still in their original
down and pick up an object from the floor (mean 15.7 residence, as opposed to 114 of 138 (83%) in the unce-
weeks vs 23.6 weeks, p = 0.0045), the ability to get in and mented group (p = 0.24).

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 CEMENTED VERSUS UNCEMENTED HEMIARTHROPLASTY FOR INTRACAPSULAR HIP FRACTURES 121

Table VII. Mean degree of residual pain at the follow-up assessments (SD, number)

Time from surgery to assessment Cemented Thompson Uncemented Moore p-value*

Eight weeks visual analogue 2.5 (1.8, 110) 3.1 (2.1, 102) 0.034
Eight weeks 2.3 (1.2, 160) 2.5 (1.3, 160) 0.155
Three months 1.9 (1.2, 164) 2.5 (1.3, 156) < 0.0001
Six months 1.8 (1.2, 147) 2.4 (1.4, 142) 0.001
Nine months 1.9 (1.3, 136) 2.2 (1.3, 133) 0.029
One year 1.8 (1.2, 141) 2.2 (1.3, 131) 0.006
Two years 1.7 (1.2, 96) 2.1 (1.4, 100) 0.034
Three years 1.7 (1.3, 70) 1.8 (1.2, 81) 0.258
Four years 1.6 (1.2, 47) 1.7 (1.2, 50) 0.95
Five years 1.7 (1.1, 26) 2.0 (1.3, 32) 0.30
* calculated with the Mann-Whitney U test

Cemented Uncemented
Many outcome measures were used in this study (approxi-
3 mately 50 comparisons). This may result in an α error, in which,
when a p-value of < 0.05 is chosen as the level of statistical sig-
Pain score

2.5
nificance, one result in 20 may show such a p-value. Using a
2 Bonferroni correction, a p-value of 0.05/50 (i.e., 0.001) may be
1.5 used. If this is applied to the key outcome measure of residual
1
pain, this still remains statistically significant. Hence, the key
finding in this study of reduced residual pain for the cemented
9 months
3 months

6 months
8 weeks

5 years
2 years

3 years

4 years
1 year

prosthesis is extremely unlikely to be due to statistical chance.

The outcome of secondary surgery, particularly revision of
the implant, was not significantly different between the two
Fig. 3
groups, although there was a tendency to more revision
Graph showing mean pain scores related to the type of treatment given. arthroplasties in the uncemented group. The outcome of revi-
sion rate for this population is not so significant as that for
elective hip arthroplasty, as the elderly population in this study
are less likely to undergo a revision arthroplasty, even if signif-
Discussion icant symptoms of residual pain exist. Data from the Austra-
This study is the largest randomised trial to date on this lian National Joint Replacement Registry9 have demonstrated
topic and confirms the results of the previous smaller stud- a reduced need for revision surgery for a cemented Thompson
ies of patients with an intracapsular hip fracture which prosthesis compared with an uncemented Austin-Moore. For
found that a cemented hemiarthroplasty leads to less resid- 15 000 registered cases, the rate of revision surgery was signif-
ual pain and a better return of mobility than an uncemented icantly higher (p < 0.001) for the uncemented prosthesis. The
prosthesis.1 We were able to demonstrate that the margin- Australian database found that four years after surgery the
ally increased operation time and the potential operative rate of revision was approximately 4% for the Thompson
complications associated with cement were not detrimen- versus 6% for the Austin-Moore prosthesis. This is compara-
tal. Indeed, the reverse was true, with a clear trend to fewer ble with the finding in this study of a rate of revision to total
general medical complications, fewer re-operations and a hip replacement of 3% for the cemented Thompson and 6%
shorter hospital stay with the cemented prosthesis. for the uncemented Austin-Moore.
The strengths of this study include the broad entry criteria, Previously published randomised trials comparing cemented
the large number of patients included, standardisation of treat- and uncemented hemiarthroplasties for patients with a fracture
ment procedures, the lack of patients lost to follow-up, and the of the hip have been identified and summarised in the
blinded assessment of outcome. The most important outcomes Cochrane Review on this subject.1 Sonne-Holm, Walter and
measured were mortality, pain and return of function. At the Jensen,10 in 1982, compared the results of a cemented and an
initial outpatient visit we assessed pain using both a visual ana- uncemented Austin-Moore hemiarthroplasty in 112 patients.
logue scale and a pain score as described by Charnley.5 For this There was no difference in mortality between the two groups.
elderly population it was found that the Charnley pain score Better walking ability and less pain was observed in those
was the most appropriate method of assessment for follow-up treated with the cemented prosthesis. Similar findings were
by telephone. We are not aware of any studies that have specif- recorded in a later study of 50 patients which compared a
ically validated the Charnley pain score, but the questions used cemented and an uncemented bipolar hemiarthroplasty.11
form the basis of most of the arthroplasty assessment scores There was no difference in mortality between the groups, but
which have been widely used and validated. significantly less pain in those treated with the cemented

VOL. 92-B, No. 1, JANUARY 2010

122 M. I. PARKER, G. PRYOR, K. GURUSAMY
Table VIII. Mean reduction in mobility scores (SD, number)
Time from surgery to assessment Cemented Thompson
Eight weeks visual analogue 2.1 (2.2, 168)
Three months 1.8 (2.1, 168)
Six months 1.4 (1.9, 150)
Nine months 1.3 (1.8, 142)
One year 1.3 (1.9, 143)
Two years 1.9 (2.0, 104)
Three years 2.0 (2.0, 73)
Four years 2.2 (2.1, 50)
Five years 2.4 (2.3, 29)
* calculated with the Mann-Whitney U test
prosthesis. Walking ability was also superior with the
cemented prosthesis. Santini et al12 also compared a
cemented and an uncemented bipolar hemiarthroplasty in
106 patients. Again, there was no difference in mortality or
functional activity between the two groups. Two studies
involving a total of 190 patients compared a cemented with
an uncemented Thompson prosthesis. Both reported no
statistically significant difference between the groups for
mortality, and significantly more residual pain in those
treated with an uncemented prosthesis.13,14 Branfoot, Faraj
and Porter15 also compared a cemented with an unce-
mented Thompson prosthesis in 91 patients and reported
no significant difference in mortality. The mean pain scores
in the 70 surviving patients tended to be higher, indicating
more pain, for the uncemented prosthesis, although the
results were not statistically significant.
We chose the two prostheses used in this study as they are
currently the most commonly used in the United Kingdom.
It is possible that a modern uncemented prosthesis, perhaps
with hydroxyapatite coating may produce superior out-
comes to the uncemented Austin-Moore prosthesis which
we used, but this remains to be proved in a randomised
controlled trial. The only study that has compared an unce-
mented Austin-Moore with a hydroxyapatite-coated Fur-
long prosthesis in 84 patients was too small to make any
definite conclusions on any difference between the two
implants.16
In summary, this study found that a cemented Thompson
hemiarthroplasty led to less pain in the hip, improved
return of mobility and a reduced hospital stay compared to
an uncemented Austin-Moore prosthesis. There was no
increase in complications or mortality related to the use of
cement. In conjunction with previous studies which have
also reported improved outcomes for a cemented rather
than an uncemented hemiarthroplasty, we suggest that
when a hemiarthroplasty is used for a fracture of the hip it
should be cemented in place.
Uncemented Moore p-value*
2.5 (2.2, 165) 0.10
2.7 (2.0, 158) 0.07
2.2 (1.9, 144) 0.005
1.9 (2.0, 135) 0.016
2.0 (2.0, 137) 0.004
2.0 (2.2, 107) 0.58
2.4 (2.3, 83) 0.42
2.7 (2.1, 52) 0.26
2.5 (2.1, 34) 0.81
The study was supported by a grant from the Peterborough Hospital Hip Frac-
ture Fund. We would like to thank the research nurses N. Smith, M. Norman, D.
Parker and K. Ruggerio for their help with the study.
No benefits in any form have been received or will be received from a com-
mercial party related directly or indirectly to the subject of this article.
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THE JOURNAL OF BONE AND JOINT SURGERY