Abstract
PURPOSE: In patients undergoing hemiarthroplasty in the elderly, the choice of the cemented method remains controversial. This meta-analysis was undertaken to compare the impact of cemented vs uncemented on outcomes for hemiarthroplasty in the elderly. METHODS: This study included randomized controlled trials comparing the postoperative effects of cemented vs uncemented in patients with hemiarthroplasty. With no language restrictions, we searched Medline (Ovid), Embase (Ovid), Cochrane Central Register of Controlled Trials (Cochrane Collaboration), Clinical Trials.gov, the ISRCTN registry, as well as gray literature with no language restrictions from January 1966 to April 2023. Data were quantitatively summarized using a random-effects model. The primary outcome was 1-year mortality. RESULTS: This study included 13 randomized controlled trials with 3485 patients. The primary outcomes of the meta-analysis showed that cemented fixation in elderly patients undergoing hemiarthroplasty was superior to noncemented in 1-year mortality (risk ratio [RR] = 0.87, 95% confidence interval [CI]: 0.77, 0.97). Moreover, cemented was associated with a reduced risk of intraoperative periprosthetic fracture (RR = 0.19, 95% CI: 0.07, 0.50), postoperative periprosthetic fracture (RR = 0.34, 95% CI: 0.16,0.72), and loosening (RR = 0.33, 95% CI: 0.11, 0.97). CONCLUSIONS: Cemented hemiarthroplasty is superior to noncemented in terms of survival. Moreover, cementation reduces the incidence of some implant-related complications. More extensive trials are needed to provide adequate guidance for choosing the proper cemented method.