Cemented vs Uncemented Total Hip Replacement: Clinical Outcomes

Primary Recommendations

The American Academy of Orthopaedic Surgeons strongly recommends cemented femoral stems for patients undergoing arthroplasty for femoral neck fractures, due to superior outcomes and reduced complications 1
Cemented femoral stems are recommended for all hip fracture arthroplasty procedures, representing the highest level of guideline support 1, 2, 3
The American Academy of Orthopaedic Surgeons recommends cemented stems for both hemiarthroplasty and total hip arthroplasty performed for acute femoral neck fractures 1

The Anaesthesia society recommends ensuring adequate hydration before and during anesthesia to prevent Bone Cement Implantation Syndrome (BCIS) 4, 5, 6, 7
The Anaesthesia society recommends using pressurized lavage system to thoroughly clean femoral canal of fat and marrow to prevent BCIS 4, 5, 7
The Anaesthesia society recommends inserting cement retrograde with distal suction catheter on intramedullary plug to prevent BCIS 4, 5, 7
The Anaesthesia society recommends avoiding excessive manual pressurization in high-risk patients to prevent BCIS 4, 5, 7
The Anaesthesia society recommends maintaining systolic blood pressure within 20% of pre-induction values using vasopressors/fluids to prevent BCIS 4, 5, 6, 7
The Praxis Medical Insights society recommends having vasopressors drawn and ready before cement application to manage BCIS 4, 5, 6, 7
The Praxis Medical Insights society recommends invasive blood pressure monitoring for high-risk patients to manage BCIS 4, 5, 6, 7
The Praxis Medical Insights society recommends monitoring for sudden drops in end-tidal CO2 indicating right heart failure to manage BCIS 7
The Praxis Medical Insights society recommends increasing FiO2 to maintain oxygenation to manage BCIS 7
The Anaesthesia society recommends establishing clear surgeon-anesthetist communication before cement insertion to manage BCIS 4, 5, 6, 7

The Praxis Medical Insights society defines Grade 1 BCIS as SpO2 <94% or >20% fall in systolic BP, with a ~20% incidence 7
The Praxis Medical Insights society defines Grade 2 BCIS as SpO2 <88% or >40% fall in systolic BP or loss of consciousness, with a ~3% incidence 7
The Praxis Medical Insights society defines Grade 3 BCIS as cardiovascular collapse requiring CPR, with a ~1% incidence 7

The Anaesthesia society notes that absolute complication rates increase with age regardless of fixation method 4, 5, 6