Cemented versus uncemented hemiarthroplasty for elderly patients with displaced fracture of the femoral neck A PRISMA-compliant meta-analysis of randomized controlled trial

Background: This meta-analysis was performed to incorporate newly published, high-quality randomized controlled trials (RCTs) to determine the effects of cemented versus uncemented hemiarthroplasty for elderly patients with displaced fracture of the femoral neck. Methods: The following electronic databases were extensively searched from the inception of the database through December 2018: EMBASE, Medline, the Cochrane Library, and Web of Science. RCTs focusing on the outcomes of cemented and uncemented hemiarthroplasty were reviewed and screened for eligibility. We used the Cochrane Collaboration's Review Manager Software to perform meta-analyses. Two independent reviewers extracted the data and assessed the study quality and bias risk through the Cochrane Collaboration tool. Use fixed effect model or random effect model to pooled data. Cochran's Q statistic was used to evaluate heterogeneity, and I(2)statistic was used to quantify heterogeneity. Results: Fifteen RCTs were enrolled (n = 3790) (uncemented hemiarthroplasty group = 1015; cemented hemiarthroplasty group = 1037) (mean age ranged from 70-85.3 years; all patients > 65 years). The meta-analysis showed that cemented hemiarthroplasty has a longer operating time (weighted mean difference, 8.03; 95% confidence interval (CI) 4.83-11.23;P < .00001), less pain (odds ratio, 0.48; 95% CI 4.83-11.23;P = .02), lower mortality 1-year (odds ratio, 0.78; 95% CI 0.62-0.98;P = .03) and fewer implant-related complications (odds ratio, 0.20; 95% CI 0.13-0.30;P < .00001) than Uncemented hemiarthroplasty. However, there are still some limitations in our study, such as the uniformity of the surgery administration programme and rehabilitation scheme, and the small sample size of the included studies. Conclusions: Cemented hemiarthroplasty for elderly patients with displaced fracture of femoral neck may acquire better functional results.