A Cochrane review [Abstract] 1 included 23 studies with a total of 2 861 older and mainly female patients with proximal femoral fractures. Cemented prostheses, when compared with uncemented (6 trials, n=899) were associated with less pain at three months (RR 0.77, 95% CI 0.60 to 0.98) and at one to two years (RR 0.55, 95% CI 0.40 to 0.75), and improved mobility. No significant difference in surgical complications was found. One study (n=220) compared a hydroxyapatite coated hemiarthroplasty with a cemented prosthesis and reported no notable differences between the two prosthesis. Comparison of unipolar hemiarthroplasty with bipolar hemiarthroplasty (7 trials, n=857) showed no significant differences between the two types of implant. Seven trials (n= 734) compared hemiarthroplasty with a total hip replacement (THR). Most studies involved cemented implants. Dislocation of the prosthesis was more common with the THR but there was a general trend within these studies to better functional outcome scores for those treated with the THR.
Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment, lack of blinding, and inadequate intention-to-treat adherence).
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