Comparison Between Cemented and Uncemented Hemiarthroplasty in Patients With Femoral Neck Fractures: A Systematic Review and Meta-analysis

Comparison Between Cemented and Uncemented Hemiarthroplasty in Patients With Femoral Neck Fractures: A Systematic Review and Meta-analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research article Comparison Between Cemented and Uncemented Hemiarthroplasty in Patients With Femoral Neck Fractures: A Systematic Review and Meta-analysis Xiu Mei Tang, Duan Wang, Ying Liu, Jia Li Chen, Pei Fang Li, Zong Ke Zhou, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-61772/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background We performed an updated systematic review and meta-analysis to compare the outcomes of CHA and UCHA in patients with FNFs. Methods We searched 6 English databases (Cochrane Library, ScienceDirect, PubMed, Embase, Medline, and Web of Science) and 4 Chinese databases (CNKI, VIP, Wang Fang, and Sino Med) in July 2020. The quality of each study was assessed according to the Cochrane handbook of systematic reviews. Data were pooled as risk ratios (RRs) and weighted mean differences (WMDs) with 95% confidence intervals (95% CIs). We used the random-effects model despite the heterogeneity among the studies. Data regarding baseline characteristics, hip function, complications both prosthetic-related and common, and operative outcomes are reported. Results A total of 24 RCTs based on 22 trials involving 3119 patients (CHA, 1575; UCHA, 1544) were included. Patients in CHA group show better hip function with HHS within 6 weeks (WMD=9.097, 95% CI, 3.034-15.161; P<0.003), 3 months (WMD=3.347, 95% CI, 1.478-5.216; P<0.001), 12 months (WMD=2.183, 95% CI, 0.161-4.205; P=0.034). The pooled results show that CHA had lower rates of refracture (RR=0.227, 95% CI, 0.135-0.381; P<0.0001), subsidence or loosening (RR=0.295, 95% CI, 0.112,0.778; P<0.014) and revision (RR=0.468, 95% CI, 0.279-0.786; P=0.004). Furthermore, CHA group tend to have lower pain(VAS score) (WMD=-0.568, 95% CI, -0.897 to -0.239; P=0.001), lower rate of pressure injury(RR=0.432, 95% CI, 0.221-0.846; P=0.014) and mortality at 1 year after surgery(RR=0.852, 95% CI, 0.727-0.998; P=0.047). UCHA showed a shorter operative duration(WMD=8.739, 95% CI, 6.354-11.124; P<0.0001). Conclusions This meta-analysis demonstrates that CHA has better hip function, lower rates of refracture, subsidence or loosening, revision, pressure ulcer, pain and one-year mortality than UCHA, while UCHA has shorter operative duration. Orthopedics Hemiarthroplasty Cemented Uncemented Outcomes Femoral Neck Fractures Complications Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Background Femoral neck fractures (FNFs) are associated with high rates of mortality and functional loss among older adults. The incidence of FNF is estimated to increase to between 7 million and 21 million per year by 2050[1]. Data from Europe have revealed that cases of FNF could surge from 615000 in 2010 to 815000 in 2025 (32%), among which the 30-day and 1-year mortality rates are more than 10% and 30%, respectively[2,3]. Hemiarthroplasty (HA) is recommended for aged FNF patients to regain acceptable functional recovery and pain relief. HA as a treatment for FNF is associated with fewer prosthesis-related complications than total hip arthroplasty and has better outcomes than internal fixation[4]. There are two different types of HA: cemented hemiarthroplasty (CHA) and uncemented hemiarthroplasty (UCHA). Polymethylmethacrylate bone cement is inserted as a bone implant in CHA, while in UCHA, the prosthesis, such as a Thompson prosthesis or modern hydroxyapatite-coated implant, is press-fit in the femur without cement. Although 8 meta-analyses have been published[5-13], the results of modern implants had not been fully considered and previous results were inconsistent, indicating a need for more robust evidence. The most recent study carried a substantial risk of bias in its methodology due to the lack of publication bias plots and sensitivity analysis for high heterogeneity outcomes and it is not known how or to what extent these risks of bias influence the findings[14]. Ahn[13] identified 11 studies, including both prospective and retrospective studies, and concluded that CHA had a lower revision rate, and UCHA had less blood loss and a shorter operative duration[13]. This review was limited by predictable bias from quasi-RCTs or non-RCTs and showed considerable heterogeneity in most results. In the first meta-analysis composed only of RCTs, Li examined 7 RCTs and found that CHA could achieve better hip function with less pain and fewer implant-related complications in elderly patients with FNF[12]. However, they still had difficulty creating funnel plots to assess the publication bias because of the limited number of trials. Ning published an updated meta-analysis including 12 studies, the results clashed with those of previous reviews and only showed that UCHA had a longer operative duration[11]. Veldman detailed postoperative complications between CHA and UCHA but only enrolled 5 studies[10]. Imam summarized 9 RCTs and 20 observations and found greater intraoperative blood loss and heterotopic ossification in CHA[9]. CHA had a higher 1-year mortality rate in several studies, but this result was revised in a later analysis[7,5]. These studies were criticized for their patients samples, inclusion criteria, poor randomization, limited reporting of outcomes, inadequate follow-up, and exclusion of modern implants. The Cochrane review concluded that patients with cemented prostheses have less pain at one year or later and had improved postoperative mobility and no differences in mortality or complications at any time point. The authors of the review acknowledged that the majority of the included studies evaluated traditional prostheses such as the cemented Thompson and uncemented Austin Moore prostheses. Thus, despite its conclusion was in favour of cementing, the review raised the need for further comparisons between cemented and more advanced uncemented implants[28]. Earlier reviews did not include a sufficient number of RCTs, which will confound the findings. Furthermore, some researchers did not apply sensitivity analysis or subgroup analysis to determine and explain heterogeneity. Some studies excluded old trials to investigate the influence of new materials but at the expense of previous data. Though these studies compared most of the variables between CHA and UCHA, we still consider that improvements are needed based on the following reasons. First, predictable bias from quasi-RCTs or non-RCTs existed in all studies. Second, complications were roughly stratified in several reviews, and no specific syndrome was analysed. Third, the purest RCT analysis only included 12 studies in 2014. Fourth, 3 of the latest RCTs, 2 of which had large samples, were published in 2020, and another was published in 2018, and these studies were not included in previous meta-analyses[15-17]. Finally, similar studies have been carried out in China but without presenting the results for worldwide discussion. The purpose of our study was to integrate the latest evidence and include high-quality Chinese studies enrolled both modern implants and traditional ones to provide an updated meta-analysis comparing the outcomes of CHA and UCHA in patients with FNF. Methods Search strategies Two investigators (TXM, WD) searched 10 data bases in July 2020. The following search terms were used: “Hemiarthroplasty” “Hemiarthroplasties”, “Hemi-Arthroplasty”, “Hemi Arthroplasty”, “Hemi-Arthroplasties”, “Femoral Neck Fractures”, “Femoral Neck Fracture”, “Femur Neck Fractures”, “Femur Neck Fracture”), “Thompson/Austin Moore prostheses”, “cemented”, “cement”, “uncemented”, “un-cemented”, and “cementless”. References cited in relevant articles were also manually searched for relevant articles. The language was restricted to English and Chinese. Eligibility and exclusion criteria The inclusion criteria were as follows: studies comparing the outcomes between CHA and UCHA among FNF patients; studies with full text and data available for further meta-analysis; and RCTs. Studies were excluded if they met the following criteria: meetings, abstracts, comments, case reports, reviews, and meta-analyses; data could not be extracted or estimated. Data extraction Two reviewers independently extracted relevant information from each eligible study using a standard form. Any disagreement was resolved by the adjudicating senior authors. Data for the following outcomes were extracted: hip function (Harris hip score, HHS), complications (prosthesis-related complications and general complications) and operative outcomes. Assessment of quality We assessed the methodological quality of the original studies using the Cochrane handbook of systematic reviews. Statistical analysis We analysed the data using Stata SE12.0. The risk of bias and publication bias was analysed by RevMan 5.3. The I 2 test was used to examine heterogeneity among studies. Heterogeneity was defined as absent (I 2 = 0.0% to 25.0%), low (I 2 = 25.1% to 50.0%), moderate (I 2 = 50.1% to 75.0%), or high (I 2 = 75.1% to 100.0%). The random-effects model was used despite heterogeneity. Sensitivity analysis was further performed by removing each study. Subgroup analysis was performed to compare the different follow-up points. All P values were two-sided and considered significant if <0.05. Results Identification of studies A total of 1145 studies were identified by the search strategies (including searching the databases, Google Scholar, and articles retrieved in the references). After automatic duplicate removal, 639 articles were saved and 24 studies were identified[17-28,16,29,15,30-38] (Fig 1. PRISMA study flow diagram). Risk of bias and publication bias The risk of bias is shown in Fig 2 . ( Fig 2. Risk of bias graph) Funnel plots were used to investigate the risk of publication bias based on the results of outcomes enrolled more than 10 studies. ( Fig 3. Publication bias ). Study characteristics We identified 24 RCTs, with 20 in English and 4 in Chinese. All selected studies were published between 1982 and 2020. The details of enrolled studies were shown in Table 1. (Table 1. Characteristics of the included studies) And we provide the synthesized meta-analysis outcomes in Table 2.( Table 2. Outcomes of meta-analysis) Hip function HHS Altogether, 21 studies provided information regarding the HHS in different stages. In our meta-analysis, CHA has higher HHS results within 6 weeks (WMD=9.097, P<0.003), 3 months (WMD=3.347, P<0.001), 12 months (WMD=2.183, P=0.034) ( Fig 4. Forest plot analysis of HHS ) . Prothesis-related complications Refractures Nine RCTs were pooled together and indicated that CHA resulted in fewer refractures than UCHA (RR= 0.227, P<0.0001) ( Fig 5. Forest plot analysis of Refracture ). Subsidence or loosening Our study find that CHA has lower rates of subsidence or loosening compared with UCHA (RR= 0.295; P<0.014) Revision The pooled results showed that CHA contributed more to reducing the reoperation rate (RR=0.468, P=0.004) Dislocations The incidence of dislocation was measured in 7 trials enrolling 1296 patients (CHA, 656; UCHA, 640). There was no significant difference between the CHA and UCHA groups. Heterotopic ossification The pooled analysis found no heterogeneity, and there was no difference within groups. Acetabular erosion The results showed no difference between the two groups. General complications Wound Infection Data regarding wound infection were reported by 13 studies in 2193 patients (1104 vs 1089). No significant difference was detected (RR=1.068, P=0.781) . Pneumonia Eleven studies reported pneumonia in 1935 patients (975 vs 960). The results showed no significant difference between the 2 groups (RR=0.799, P=0.282) . Cardiovascular Disease We combined the mentioned symptoms, such as tachycardia, arrhythmia, myocardial infarction together as cardiovascular complications. And there was no significant difference between the two groups (RR=1.278, P=0.324). Urinary Tract Infection Seven articles considered urinary tract infections and investigated 812 patients (409 vs 403). No significant difference was found between the groups (RR=1.087, P=0.683). Pain (Visual analogue scale, VAS) Six studies showed that CHA has lower VAS(WMD = -0.568, P=0.001) . Deep Vein Thrombosis Five included articles reported deep vein thrombosis in 1174 patients (598 vs 576). There was no significant difference between the two groups (RR=1.050, P=0.910). Pressure Injury Five trials reported pressure injury in 1069 patients (530 vs 529). The results showed that UCHA carried a higher risk of pressure injury event (RR=0.432, P=0.014). Pulmonary Embolism Five trials reported pulmonary embolism in 1160 patients (590 vs 570). The rate of pulmonary embolism was higher in CHA group but the difference was not significant (RR=2.556, P=0.063). Renal Failure Renal failure was measured in 4 enrolled studies. The result suggested that there was no difference (RR= 0.972, P=0.954) . Gastric Bleeding Four studies provided information on gastric bleeding. The limited data showed no significant difference (RR=1.382, P=0.614) . Hematoma No significant difference was found regarding hematoma (RR=1.836, P=0.287) . Mental Status Change No significant difference was found (RR=0.862, P=0.476) . Operative Outcomes Surgery Length Nineteen studies reported the operative duration. It was longer in the CHA group (WMD=8.739, P<0.00001). Blood loss This parameter was measured by 15 studies in 2277 people (CHA, 1142; UCHA, 1135). There was no significant difference(WMD=26.218mL, P=0.085), but the results should be considered carefully due to the high heterogeneity (P<0.0001, I 2 =80.4%) . Hospital Length The length of hospital stay was described by 10 studies including 1450 patients. CHA has shorter overall length of hospital stay, although there was no significant difference(WMD=-0.330, P=0.279). Blood Transfusion The pooled effect of 6 RCTs (n= 1682) did not favour either of the two groups in terms of blood transfusion (RR=1.000, P=0.999). Mortality The results showed no significant differences between the CHA and UCHA groups for mortality within, within 6 months, and after 2 years. However, the mortality was slightly higher at one year in UCHA group . Discussion Hip function Barenius[17] found hip function recovery was better in the CHA group in the short term but it deteriorated over time, with no statistically significant difference at 48 months. Khorami[24] and Li[39] described the HHS grade with no specific numbers, so we excluded their data. Taylor[36] used the Oxford hip score (OHS) to assess hip function and concluded that the results were poorer in the UCHA group at 6 weeks, which is in agreement with the result reported by Singh[33]. The OHS is a validated instrument for assessing the outcome of hip replacement based on patient perception in terms of hip pain and function. Since the grouping is arbitrary and is not suggested by the originators of the OHS, we did not synthesize the data from studies using these instruments. DeAngelis[18] collected information about hip function using the Instrumental Activities of Daily Living and Physical Activities of Daily Living scales and the Energy/Fatigue Scale Instruments. The results showed no statistically significant difference in functional outcomes[18]. Parker[15] measured each patient’s walking ability using a mobility scale adapted from a hip fracture mobility score and found that patients in the CHA group regained a better degree of mobility at 1 year. His study, performed 10 years ago, also found better scores for 3 of 16 activities of daily living in the CHA group[29]. Moroni’s[28] study is different from most other studies, and we found that one possible reason may be that the implants he used were Furlong prostheses coated with HA. The outcomes obtained with the Furlong prosthesis may be due to the advantages of the HA coating in binding with osteoporotic bone, thus establishing stable fixation in patients[28]. Santini[31] used the total functional score (ranging from 0 to 18 points) to evaluate walking ability and personal daily activity. There was no difference regarding the total functional score[31]. Sonne-holm[40] assessed hip function according to pain, gait function, and hip mobility on a scale of 0-6. CHA yielded significantly better results at 3 and 6 months, but after 1 year, approximately 40% of all patients had normal gait function. Emery and Dorr also described similar results in that patients treated with CHA showed a better ability to walk[20,19]. Due to the loss of patients over the long follow-up in Lanslet’s study, their results showing that the HHS favoured the uncemented group should be interpreted cautiously[25]. It was difficult to pool data from previous studies due to the inconsistency of the outcome parameters. Therefore, we used the HHS score as a standard parameter with a large sample and confirmed that CHA led to better hip function up to 12 months, with no difference thereafter. The reason may be that bone cement forms a solid bond between the stem and bone, providing favourable biomechanical advantages, further reducing the degree of early postoperative pain, and leading to better mobility and early mobilization. Limited long-term follow-up trials were included in our analysis, and we suggest that future studies should enrol more long-term follow-up trials. Prothesis-related complications The increased occurrence of prosthesis-related complications is highly suspected as the reasons for the greater pain and inferior hip function recovery in UCHA, generating a vicious cycle of worse outcomes in patients. Large database as reports from the Norwegian hip fracture register show a doubling need for secondary surgery in UCHA. Our study is in favour of previous registry outcomes and found that the rates of refracture, loosening or subsidence, and revision were obviously lower in the CHA group. According to Vidovic, one of the possible reasons for these results may be that patients in CHA group get improved function and weight-bearing (higher HHS) and can promote bone formation thus had lower periprosthetic bone loss[37]. Another reason for prosthesis-related complications is more in CHA may be that when surgeons use press-fitting to place uncemented stems, accidental fracture during insertion or broaching can occur. Some new uncemented stems have been used in several studies and proven to yield better results. Song[41] pointed out that higher refracture rates are associated with the use of modern uncemented stems compared to cemented stems in FNF. These complications still exist despite the evolving designs and materials[10]. Our results also supported these points. We recommend that new materials should be considered in combination with patients' conditions, such as canals or bone quality. Technically, the procedure should yield tight contact between the prosthesis and the endosteal bone surface through careful steps during the surgery and without the use of brutal force. Common complications Pressure Injury A significant difference was revealed regarding pressure injury, which was not found by previous studies. This suggests that our meta-analysis achieved greater power in detecting significant differences. Interestingly, cardiovascular complications were similar between groups in our study, which is contrary to the widely accepted view that CHA is associated with higher vascular complications. This may be explained by the prevailing idea of enhanced recovery after surgery and the large number of surgeons who are now mobilizing patients early. Our study shows that pneumonia and urinary tract infection occurred less frequently in the CHA group, with no statistically significant difference. This is consistent with Yoon’s[42] conclusion. This may be due to early ambulation or early urinary catheter removal in the CHA group[42]. Pain Postoperative pain may hinder patients from weight-bearing, disturbing bone mass recovery and function regain [37]. In previous studies, pain was less common in the CHA group, but the incidence differed [15,12]. Of the 24 included RCTs, some recorded patients with pain or without pain; some used the visual analogue scale (VAS) score or the HHS pain sub-score to evaluate pain. After pooling the data, we found lower VAS score in the CHA group. Operative outcomes Our results demonstrate that CHA was associated with a significantly prolonged operative duration (WMD=8.739minutes, p<0.0001), which is consistent with the results of other studies. This finding is probably partly due to the waiting periods required for cement polymerization, insertion and solidification. There was no difference in the volume of blood loss or the length of hospital stay. These results may be due to earlier mobilization after CHA than UCHA, thus reducing the hospital time. However, it is not clear whether these patients still go to nursing homes or other rehabilitation facilities for recovery, and the lack of recorded data may cause confusion. However, due to the ways used in different areas in measuring blood loss, we can not analysis the high heterogeneity and the results should be explained carefully. What should be noted is that the blood transfusion requirement is similar within groups, and it remind us it may be less important to care for the intraoperative blood loss. Mortality Whether CHA has a higher mortality rate than UCHA has long been debated. Kumar[8] reported that CHA had higher 1-year mortality, while Kristensen[6] showed that there was no difference. Our study shows that the mortality rate lower at 1 year postoperatively in CHA group, which is consistent with mainstream previous reports[5,7,43]. CHA can lead to death due to bone cement implantation syndrome (BCIS), which occurs at a rate of approximately 0.5%~0.6%[15]. The latest RCT reported 3 deaths that may have been caused by BCIS [15], and Moerman also reported one death possible caused by it[26]. Similar events have been reported by other trials, as well as Australian joint replacement registry[23,21,44]. Movrin[16] noted that there were 8 (10.1%) events of an intraoperative drop in the oxygen saturation (SaO2) in the CHA group, which may have been the reason for BCIS. In a cohort study, Costain[45] et al found a significant difference in the one-day mortality rate, at 0.5% in the UCHA group and 0.8% in the CHA group (p < 0.001)[8]. Two large studies of over 20,000 patients each showed that perioperative death was significantly increased in CHA due to BCIS[46,47]. Regarding long-term effects, Ekman holds the view that greater mortality in the longer term after CHA is related to comorbidities[43]. Both surgeons and anaesthesiologists should consider patients’ intraoperative blood pressure and oxygen saturation. Thus, we suggest that surgeons determine the best type of surgical procedure based on each patient’s own conditions, including physiology, morbidities and cardiovascular condition and follow the guidelines of management of BCIS. Conclusions This meta-analysis demonstrates that CHA has better hip function, lower rates of refracture, subsidence or loosening, revision, VAS scores, pressure injury event and one-year mortality than UCHA; UCHA had shorter operative duration. We believe we are by far the first study enrolled the largest number of RCTs and included the most details of modern implants and traditional ones. We firmly believe our conclusion is stable and reliable. Our study also has several limitations. We did not exclude studies based on criteria such as the implant type (e.g., unipolar or bipolar), patient age, or stem design (e.g., modern or traditional). The latter makes our study generalizable to all elderly patients treated with hemiarthroplasty. List Of Abbreviations RCTs: Randomized controlled trials; CHA: Cemented hemiarthroplasty; UCHA: Uncemented hemiarthroplasty; FNF: Femoral neck fracture; WMD: Weight mean deviation; CI: Confidence interval; RR: Risk ratio; HHS: Harris hip score; VAS: Visual analogue scale; OHS: Oxford hip score; Bone cement implantation syndrome: BCIS Declarations Ethics approval and consent to participate This meta-analysis and all the included studies meet all the ethical standards described in the declaration of Helsinki. No ethical committee approval was required for this study. Consent for publication All authors have stated for consents of publications. Availability of data and materials The datasets used and analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare no competing interests. Funding No funding was available for this study. Authors' contributions TXM conceived the methods of the study, performed the database search, the article selection and data extraction processes, performed the statistical analysis and drafted the manuscript. WD conceived the methods of the study, performed the database search, the article selection and data extraction processes, and drafted the manuscript. NN conceived the methods of the study, helped with the data extraction process, and drafted the manuscript. LY, CJL, LPF, and ZZZ helped to draft the manuscript. All authors read and approved the manuscript. Acknowledgements Not applicable References Gullberg B, Johnell O, Kanis JA (1997) World-wide projections for hip fracture. Osteoporosis International 7 (5):407-413. doi:10.1007/pl00004148 Foss NB, Kehlet H (2005) Mortality analysis in hip fracture patients: implications for design of future outcome trials. 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Journal of bone and joint surgery - british volume 91-B (SUPP_I):167 Parker MI, Pryor G, Gurusamy K (2010) Cemented versus uncemented hemiarthroplasty for intracapsular hip fractures: A randomised controlled trial in 400 patients. The Journal of bone and joint surgery British volume 92 (1):116-122. doi:10.1302/0301-620x.92b1.22753 Qi G (2017) Contrast of effect and prognosis of artificial hip joint maken by biomaterials and bone-cement for femoral neck fracture. Orthopaedic Biomechanics Materials and Clinical Study 14 (01):53-55+60. doi:10.3969/j.issn.1672.2017.01.014 Santini S, Rebeccato A, Bolgan I, Turi G (2005) Hip fractures in elderly patients treated with bipolar hemiarthroplasty: comparison between cemented and cementless implants. Journal of orthopaedics and traumatology 6 (2):80-87 Shenqi P (2013) Comparison of the efficacy of bone cement type and non-bone cement type hemihip replacement for displaced femoral neck fracture. Chinese Journal of Postgraduates of Medicine 36 (17):41-43. doi:10.3760/cma.j.issn.1673-4904.2013.17.015 Singh GK, Deshmukh RG (2006) Uncemented Austin-Moore and cemented Thompson unipolar hemiarthroplasty for displaced fracture neck of femur--comparison of complications and patient satisfaction. Injury 37 (2):169-174. doi:10.1016/j.injury.2005.09.016 Sonne-Holm S, Walter S, Jensen JS (1982) Moore hemi-arthroplasty with and without bone cement in femoral neck fractures. A clinical controlled trial. Acta orthopaedica Scandinavica 53 (6):953-956. doi:10.3109/17453678208992854 Talsnes O, Hjelmstedt F, Pripp AH, Reikerås O, Dahl OE (2013) No difference in mortality between cemented and uncemented hemiprosthesis for elderly patients with cervical hip fracture. A prospective randomized study on 334 patients over 75 years. Archives of orthopaedic and trauma surgery 133 (6):805‐809. doi:10.1007/s00402-013-1726-5 Taylor F, Wright M, Zhu M (2012) Hemiarthroplasty of the hip with and without cement: a randomized clinical trial. Journal of bone and joint surgery American volume 94 (7):577‐583. doi:10.2106/JBJS.K.00006 Vidovic D, Punda M, Darabos N, Bekavac-Beslin M, Bakota B, Matejcic A (2015) Regional bone loss following femoral neck fracture: A comparison between cemented and cementless hemiarthroplasty. Injury 46 Suppl 6:S52-56. doi:10.1016/j.injury.2015.10.069 Xingwang L (2017) Comparison of the efficacy of cement and non-cement bone in the treatment of femoral neck fractures in the elderly. Contemporary Medicine 23 (No.464). doi:doi:10.3969/j. Jianguo L (2017) comparison of the effects and complications f biotype and cement-based artificial hip prsthesis in the treatment of femoral neck fracture in the elderly. Clinical Medicine of China 33 (12) Sonne-Holm S, Walter S, Jensen JS (1982) Moore hemi-arthroplasty with and without bone cement in femoral neck fractures. A clinical controlled trial. Acta orthopaedica Scandinavica 53 (6):953-956 Song JSA, Dillman D, Wilson D, Dunbar M, Richardson G (2019) Higher periprosthetic fracture rate associated with use of modern uncemented stems compared to cemented stems in femoral neck fractures. Hip international : the journal of clinical and experimental research on hip pathology and therapy 29 (2):177-183. doi:10.1177/1120700018772291 Yoon BH, Seo JG, Koo KH (2017) Comparison of Postoperative Infection-Related Complications between Cemented and Cementless Hemiarthroplasty in Elderly Patients: A Meta-Analysis. Clin Orthop Surg 9 (2):145-152. doi:10.4055/cios.2017.9.2.145 Ekman E, Laaksonen I, Isotalo K, Liukas A, Vahlberg T, Makela K (2019) Cementing does not increase the immediate postoperative risk of death after total hip arthroplasty or hemiarthroplasty: a hospital-based study of 10,677 patients. Acta orthopaedica 90 (3):270-274. doi:10.1080/17453674.2019.1596576 Kristensen T, Dybvik E, Kristoffersen M, Engesaeter L, Furnes O, Gjertsen J-E (2019) Cemented or Uncemented Hemiarthroplasty for Femoral Neck Fracture? Data from the Norwegian Hip Fracture Register. Clinical Orthopaedics and Related Research 478. doi:10.1097/CORR.0000000000000826 Costain DJ, Whitehouse SL, Pratt NL, Graves SE, Ryan P, Crawford RW (2011) Perioperative mortality after hemiarthroplasty related to fixation method. Acta orthopaedica 82 (3):275-281. doi:10.3109/17453674.2011.584208 Costain DJ, Whitehouse SL, Pratt NL, Graves SE, Ryan P, Crawford RW (2011) Perioperative mortality after hemiarthroplasty related to fixation method. Acta orthopaedica 82 (3):275-281. doi:10.3109/17453674.2011.584208 Middleton R, Uzoigwe C, Young P, Smith R, Gosal H, Holt G (2014) Peri-operative mortality after hemiarthroplasty for fracture of the hip DOES CEMENT MAKE A DIFFERENCE? The bone & joint journal 96-B:1185-1191. doi:10.1302/0301-620X.96B9.33935 Tables Table 1 Characteristics of the included studies Studies Period Age CH/UCHA Gender male/female Bipolar/ unipolar Number CH/UCHA ASA (1,2/3,4) (Mean Score) Surgeon Implants type CH/UCHA Follow-up Surgical approach Barenius2018 [3] 2009.10-2013.04 81.2(8.95)/81.3(7.81) 41/99 a 67/74 67/141 14 OS (Experienced) Cemented Unipolar Exeter stem 1 /Uncemented Unipolar Hydroxyapatite-coated Bimetric stem 2 24m/48m DLA DeAngelis2012 [5] 2005.03-2008.05 81.8(9.0)/ 82.8(7.6) 30/100 a 66/64 110/20 OS (Attending) Cemented Unipolar Femoral Prosthesis 3 /Uncemented Unipolar Component 4 1m/2m/1y SA/PA Dorr1986 [6] 1980.03-1982.07 72（10.390/ 66(12.73) 15/35 b 37/13 N/A N/A N/A 2 to 4 year PA Emery1991 [8] unclear 78(7.2)/ 79.6(8) 7/46 b 27/26 N/A Junior OS (Same group) Thompson 5 /Austin Moore 5 24m N/A Figved2009 [9] 2004.09-2006.08 83.4(5.68)/83.0(6.29) 53/167 b 112/108 94/126 OS Spectron TM 6 / Corail-1 7 3m/12m PA Guo2017 [33] 2010.06-2014.12 66.2(15.8)/ 68.7(16.8) 59/41 N/A 50/50 N/A N/A N/A 2w/4w/3m/12m Up to 1 year MPA Inngul2015 [16] 2009.10-2013.04 81.2(8.95)/81.3(7.81) 41/99 a 67/74 67/141 14 OS (Experienced) Cemented Unipolar Exeter stem 1 /Uncemented Unipolar Hydroxyapatite-coated Bimetric stem 2 4m/12m DLA Khorami2016 [18] 2011-2012 79(6.38)/71.7(3.19) 19/32 b 22/29 N/A OS Bipolar Zimmer femoral 1m/6m N/A Langslet2014 [21] 2004.09-2006.08 83.4(5.68)/83.0(6.29) 53/167 b 112/108 94/126 OS Spectron TM 6 / Corail-1 7 5y PA Li2017 [17] 2013.10-2015.10 70.2(2.4)/ 69.6(2.2) 36/79 N/A 40/39 N/A N/A N/A 3m/6m/12m PA Moerman2017 [25] 2008.08-2012.06 84(6.7)/83(6.2) 58/143 a 110/91 135/66 Orthopedic surgeon/Registrar Cemented Müller Straight Stem 8 /Uncemented DB-10 9 12m LA/PA/SA Mohabey2017 [26] 2014.09-2015.12 70.03(11.55) 18/22 b 20/20 N/A N/A Cemented modular/Uncemented modular bipolar 6m N/A Moroni2018 [27] N/A 75(5) 0/40 a 22/18 N/A OS AHS prosthesis/HA-coated Furlong prosthesis 3y N/A Movrin2020 [28] 2013.01-2015.12 86(5)/ 84(4) 64/94 b 79/79 86/72 9 consultants/specialist orthopedic trauma surgeons modular bipolar prosthesis, 80-mg Palacos cement 10 / uncemented modular bipolar 6w/3m/6m/12m/24m Up to 2years SA Parker2020 [31] 2013.08-2018.06 77.1(8.4)/ 77.1(6.35) 127/277 a 200/200 71/329 Lead trialist (MJP) cemented unipolar double-tapered stem 11 Biomet/ uncemented fully hydroxyapatite-coated Furlong 12 3m/6m/9m/12m Up to 1 year HDLA Parker2010 [30] 2001.03-2006.11 83(10.46)/ 83(12.12) 92/308 a 200/200 2.7/2.7 1 OS Thompson 13 /Austin-Moore 14 3m/6m/9m/12m Up to 5 years SA Pan2013 [35] 2005.10-2011.10 70.5(5.5)/ 72.2(7.6) 19/61 N/A 41/39 N/A OS N/A 1y Revised Gibson Singh2005 [36] 1999.01-2000.12 84/83 8/46 a 25/29 N/A consultant OS/ middle grade OS/ SHO Thompson/Austin-Moore 6w/3m/6m/9m/12m N/A Santini2005 [34] 2000.09-2001.12 82.09(7.60)/ 79.68(8.62) 60/46 b 53/53 11/105 N/A N/A 6m/12m N/A Sonne-Holm1982 [38] 1979 N/A 37/75 N/A 55/57 N/A N/A Moore cemented methyl-methacrylate/ Moore uncemented prosthesis 6w/3m/6m/12m N/A Talsnes2013 [40] 2005-2010 84.0(5.1)/84.3(5.0) 82/252 N/A 162/172 138/196 N/A bipolar cemented 15 / bipolar non-cemented 16 12m N/A Taylor2013 [41] 2006.05-2008.11 85.3(7)/85.1(6.6) 50/110 a 80/80 N/A consultant OS Cemented modular Exeter stem with an appropriately sized UniTrax head (Stryker)/uncemented Alloclassic stem with an appropriately sized head 6w/6m/1y/2y Up to 2 years HDLA Vidovic2013 [43] 2007.01-2010.12 82.9(4.63)/82.04(4.32) 0/79 a 38/41 N/A 5 OS (Experienced) Cemented Modular/Cementless Modular Austin Moore 3m/6m/12m Up to 1 year DLA Zhao2012 [14] 2008.07-2011.06 77.03(5.17)/76.34(5.62) 40/91 b 67/64 N/A 1 OS group N/A 3m/12m/2y Up to 2 years PA(Moore) Unipolar Bipolar N/A. not find OS. orthopedic surgeon DLA: direct lateral approach SA: standard anterolateral approach PA: Posterior approach MPA: Modified posterolateral approach HDLA: Hardinge direct lateral approach Stryker, Kalamazoo, Michigan Zimmer Biomet, Warsaw, Indiana VerSys LD/Fx; Zimmer, Warsaw, IN VerSys Beaded FullCoat; Zimmer, Warsaw, IN Monk duoplet design (Johnson & Johnson, England) Smith & Nephew, Inc, Memphis, TN DePuy International Ltd, Leeds, UK Zimmer - Biomet, 1800 West Center St. Warsaw, Indiana, USA Zimmer- Biomet, 1800 West Center St. Warsaw, Indiana, USA Heraeus, Wehrheim, Germany Exeter Trauma Stem, Stryker Medical, Michigan, USA, or CPT Zimmer/Biomet, Warsaw, Indiana, USA JRI Orthopaedics, Sheffield, UK Stryker/Howmedica Ltd, Newbury, United Kingdom Corin Ltd, Cirencester , United Kingdom Landos Titan, Depuy, Warshaw, IN, USA Landos Corail, Depuy, Warshaw, IN, USA Table 2 Outcomes of meta-analysis Variables N (study) N (CH) N (UCH) Pooled data WMD/RR (95% CI) P Heterogeneity I² (%) Ph Hip Function(HHS) HHS（<6 week) 2 122 126 9.097(3.034,15.161) <0.003* 75.8% 0.042 HHS（3 months) 5 291 282 3.347(1.478,5.216) <0.0001* 45.5% 0.119 HHS（6 months) 3 98 100 0.217(-5.860,6.294) 0.944 91.9% <0.0001 HHS（12 month) 7 375 375 2.183(0.161,4.205) 0.034* 39.9% 0.125 HHS（24 to 60 months) 4 156 186 0.337(-2.945,3.619) 0.840 50.7% 0.037 Prothesis-related Complications Refracture 9 910 898 0.227(0.135,0.381) <0.0001* 0.00% 0.941 Subsidence or Loosening 9 485 467 0.295(0.112,0.778) <0.014* 49.30% 0.061 Revision 9 749 771 0.468(0.279,0.786) 0.004* 0.00% 0.781 Dislocation 7 656 640 1.036(0.496,2.161) 0.926 0.00% 0.753 Heterotopic Ossification 5 265 261 0.983(0.759,1.272) 0.894 0.468 0.00% Acetabular Erosion 3 189 205 1.769(0.400,7.831) 0.452 0.229 32.10% General Complications Wound Infection 13 1104 1089 1.068(0.670,1.703) 0.781 0.872 0.00% Pneumonia 11 975 960 0.799(0.532,1.202) 0.282 0.791 0.00% Cardiovascular Disease 8 796 793 1.278(0.785,2.078) 0.324 0.788 0.00% Urinary Tract Infection 7 409 403 1.087(0.727,1.625) 0.683 0.811 0.00% VAS 6 520 525 -0.568(-0.897, -0.239) 0.001* 0.017 63.6% Deep Vein Thrombosis 5 598 576 1.050(0.452,2.439) 0.910 0.876 0.00% Pressure Injury 5 530 529 0.432(0.221, 0.846) 0.014* 0.802 0.00% Pulmonary Embolism 5 590 570 2.556(0.951,6.870) 0.063 0.814 0.00% Renal Failure 4 577 565 0.972(0.366,2.581) 0.954 0.521 0.00% Gastric Bleeding 4 563 544 1.382(0.393,4.869) 0.614 0.308 16.7% Hematoma 3 510 491 1.836(0.599,5.622) 0.287 0.480 0.00% Mental Status Change 3 510 491 0.862(0.572,1.298) 0.476 0.725 0.00% Operative Outcomes Surgery Length 19 1458 1445 8.739(6.354,11.124) <0.0001* 72.7% <0.0001 Blood Loss 15 1142 1135 26.218(-3.572,56.008) 0.085 80.4% <0.0001 Hospital Length 10 731 719 -0.330(-0.927,0.267) 0.279 9.5% 0.355 Required Blood Transfusion 6 849 833 1.000(0.805,1.243) 0.999 46% 0.099 Mortality 30-day 9 762 748 1.046(0.703,1.557) 0.824 0.00% 0.663 2 to 6 months 10 911 822 0.943(0.786, 1.131) 0.526 0.00% 0.946 1-year 8 855 834 0.852(0.727,0.998) 0.047* 0.00% 0.797 2-year 7 628 628 1.009(0.870,1.171) 0.902 0.00% 0.936 3 to 5 years 4 667 674 1.032(0.970,1.098) 0.324 0.00% 0.854 *OR or WMD considered statistically significant (p < 0.05) RR, risk ratio (for dichotomous outcomes); WMD, weighted mean difference (for continuous outcomes); CI, confidence interval; UCH, uncemented hemiarthroplasty; CH, cemented hemiarthroplasty Supplementary Files PRISMAChecklist.doc Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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The incidence of FNF is estimated to increase to between 7 million and 21 million per year by 2050[1]. Data from Europe have revealed that cases of FNF could surge from 615000 in 2010 to 815000 in 2025 (32%), among which the 30-day and 1-year mortality rates are more than 10% and 30%, respectively[2,3].\u003c/p\u003e\n\u003cp\u003eHemiarthroplasty (HA) is recommended for aged FNF patients to regain acceptable functional recovery and pain relief. HA as a treatment for FNF is associated with fewer prosthesis-related complications than total hip arthroplasty and has better outcomes than internal fixation[4]. There are two different types of HA: cemented hemiarthroplasty (CHA) and uncemented hemiarthroplasty (UCHA). Polymethylmethacrylate bone cement is inserted as a bone implant in CHA, while in UCHA, the prosthesis, such as a Thompson prosthesis or modern hydroxyapatite-coated implant, is press-fit in the femur without cement.\u003c/p\u003e\n\u003cp\u003eAlthough 8 meta-analyses have been published[5-13], the results of modern implants had not been fully considered and previous results were inconsistent, indicating a need for more robust evidence. The most recent study carried a substantial risk of bias in its methodology due to the lack of publication bias plots and sensitivity analysis for high heterogeneity outcomes and it is not known how or to what extent these risks of bias influence the findings[14]. Ahn[13] identified 11 studies, including both prospective and retrospective studies, and concluded that CHA had a lower revision rate, and UCHA had less blood loss and a shorter operative duration[13]. This review was limited by predictable bias from quasi-RCTs or non-RCTs and showed considerable heterogeneity in most results. In the first meta-analysis composed only of RCTs, Li examined 7 RCTs and found that CHA could achieve better hip function with less pain and fewer implant-related complications in elderly patients with FNF[12]. However, they still had difficulty creating funnel plots to assess the publication bias because of the limited number of trials. Ning published an updated meta-analysis including 12 studies, the results clashed with those of previous reviews and only showed that UCHA had a longer operative duration[11]. Veldman detailed postoperative complications between CHA and UCHA but only enrolled 5 studies[10]. Imam summarized 9 RCTs and 20 observations and found greater intraoperative blood loss and heterotopic ossification in CHA[9]. CHA had a higher 1-year mortality rate in several studies, but this result was revised in a later analysis[7,5]. These studies were criticized for their patients samples, inclusion criteria, poor randomization, limited reporting of outcomes, inadequate follow-up, and exclusion of modern implants. The Cochrane review concluded that patients with cemented prostheses have less pain at one year or later and had improved postoperative mobility and no differences in mortality or complications at any time point. The authors of the review acknowledged that the majority of the included studies evaluated traditional prostheses such as the cemented Thompson and uncemented Austin Moore prostheses. Thus, despite its conclusion was in favour of cementing, the review raised the need for further comparisons between cemented and more advanced uncemented implants[28].\u003c/p\u003e\n\u003cp\u003eEarlier reviews did not include a sufficient number of RCTs, which will confound the findings. Furthermore, some researchers did not apply sensitivity analysis or subgroup analysis to determine and explain heterogeneity. Some studies excluded old trials to investigate the influence of new materials but at the expense of previous data. Though these studies compared most of the variables between CHA and UCHA, we still consider that improvements are needed based on the following reasons. First, predictable bias from quasi-RCTs or non-RCTs existed in all studies. Second, complications were roughly stratified in several reviews, and no specific syndrome was analysed. Third, the purest RCT analysis only included 12 studies in 2014. Fourth, 3 of the latest RCTs, 2 of which had large samples, were published in 2020, and another was published in 2018, and these studies were not included in previous meta-analyses[15-17]. Finally, similar studies have been carried out in China but without presenting the results for worldwide discussion. The purpose of our study was to integrate the latest evidence and include high-quality Chinese studies enrolled both modern implants and traditional ones to provide an updated meta-analysis comparing the outcomes of CHA and UCHA in patients with FNF.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eSearch strategies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwo investigators (TXM, WD) searched 10 data bases in July 2020. The following search terms were used: \u0026ldquo;Hemiarthroplasty\u0026rdquo; \u0026ldquo;Hemiarthroplasties\u0026rdquo;, \u0026ldquo;Hemi-Arthroplasty\u0026rdquo;, \u0026ldquo;Hemi Arthroplasty\u0026rdquo;, \u0026ldquo;Hemi-Arthroplasties\u0026rdquo;, \u0026ldquo;Femoral Neck Fractures\u0026rdquo;, \u0026ldquo;Femoral Neck Fracture\u0026rdquo;, \u0026ldquo;Femur Neck Fractures\u0026rdquo;, \u0026ldquo;Femur Neck Fracture\u0026rdquo;), \u0026ldquo;Thompson/Austin Moore prostheses\u0026rdquo;, \u0026ldquo;cemented\u0026rdquo;, \u0026ldquo;cement\u0026rdquo;, \u0026ldquo;uncemented\u0026rdquo;, \u0026ldquo;un-cemented\u0026rdquo;, and \u0026ldquo;cementless\u0026rdquo;. References cited in relevant articles were also manually searched for relevant articles. The language was restricted to English and Chinese.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEligibility and exclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe inclusion criteria were as follows: studies comparing the outcomes between CHA and UCHA among FNF patients; studies with full text and data available for further meta-analysis; and RCTs.\u003c/p\u003e\n\u003cp\u003eStudies were excluded if they met the following criteria: meetings, abstracts, comments, case reports, reviews, and meta-analyses; data could not be extracted or estimated.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData extraction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwo reviewers independently extracted relevant information from each eligible study using a standard form. Any disagreement was resolved by the adjudicating senior authors.\u003c/p\u003e\n\u003cp\u003eData for the following outcomes were extracted: hip function (Harris hip score, HHS), complications (prosthesis-related complications and general complications) and operative outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssessment of quality\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe assessed the methodological quality of the original studies using the Cochrane handbook of systematic reviews.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe analysed the data using Stata SE12.0. The risk of bias and publication bias was analysed by RevMan 5.3. The I\u003csup\u003e2\u003c/sup\u003e test was used to examine heterogeneity among studies. Heterogeneity was defined as absent (I\u003csup\u003e2\u003c/sup\u003e = 0.0% to 25.0%), low (I\u003csup\u003e2\u003c/sup\u003e= 25.1% to 50.0%), moderate (I\u003csup\u003e2\u003c/sup\u003e= 50.1% to 75.0%), or high (I\u003csup\u003e2\u003c/sup\u003e= 75.1% to 100.0%). The random-effects model was used despite heterogeneity. Sensitivity analysis was further performed by removing each study. Subgroup analysis was performed to compare the different follow-up points. All P values were two-sided and considered significant if \u0026lt;0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eIdentification of studies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 1145 studies were identified by the search strategies (including searching the databases, Google Scholar, and articles retrieved in the references). After automatic duplicate removal, 639 articles were saved and 24 studies were identified[17-28,16,29,15,30-38] \u003cstrong\u003e(Fig 1. PRISMA study flow diagram).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRisk of bias and publication bias\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe risk of bias is shown \u003cstrong\u003ein \u003c/strong\u003e\u003cstrong\u003eFig 2\u003c/strong\u003e. (\u003cstrong\u003eFig 2. Risk of bias graph)\u003c/strong\u003eFunnel plots were used to investigate the risk of publication bias based on the results of outcomes enrolled more than 10 studies. \u003cstrong\u003e(\u003c/strong\u003e\u003cstrong\u003eFig 3. Publication bias\u003c/strong\u003e\u003cstrong\u003e).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe identified 24 RCTs, with 20 in English and 4 in Chinese. All selected studies were published between 1982 and 2020. The details of enrolled studies were shown in \u003cstrong\u003eTable 1. (Table 1. Characteristics of the included studies)\u003c/strong\u003eAnd we provide the synthesized meta-analysis outcomes in \u003cstrong\u003eTable 2.( Table 2.\u003c/strong\u003e\u003cstrong\u003eOutcomes of meta-analysis) \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHip function\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHHS\u003c/p\u003e\n\u003cp\u003eAltogether, 21 studies provided information regarding the HHS in different stages. In our meta-analysis, CHA has higher HHS results within 6 weeks (WMD=9.097, P\u0026lt;0.003), 3 months (WMD=3.347, P\u0026lt;0.001), 12 months (WMD=2.183, P=0.034) \u003cstrong\u003e(\u003c/strong\u003e\u003cstrong\u003eFig 4. Forest plot analysis of HHS\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProthesis-related complications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRefractures\u003c/p\u003e\n\u003cp\u003eNine RCTs were pooled together and indicated that CHA resulted in fewer refractures than UCHA (RR= 0.227, P\u0026lt;0.0001) \u003cstrong\u003e(\u003c/strong\u003e\u003cstrong\u003eFig 5. Forest plot analysis of Refracture\u003c/strong\u003e\u003cstrong\u003e).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSubsidence or loosening\u003c/p\u003e\n\u003cp\u003eOur study find that CHA has lower rates of subsidence or loosening compared with UCHA (RR= 0.295; P\u0026lt;0.014)\u003c/p\u003e\n\u003cp\u003eRevision\u003c/p\u003e\n\u003cp\u003eThe pooled results showed that CHA contributed more to reducing the reoperation rate (RR=0.468, P=0.004)\u003c/p\u003e\n\u003cp\u003eDislocations\u003c/p\u003e\n\u003cp\u003eThe incidence of dislocation was measured in 7 trials enrolling 1296 patients (CHA, 656; UCHA, 640). There was no significant difference between the CHA and UCHA groups.\u003c/p\u003e\n\u003cp\u003eHeterotopic ossification\u003c/p\u003e\n\u003cp\u003eThe pooled analysis found no heterogeneity, and there was no difference within groups.\u003c/p\u003e\n\u003cp\u003eAcetabular erosion\u003c/p\u003e\n\u003cp\u003eThe results showed no difference between the two groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGeneral complications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWound Infection\u003c/p\u003e\n\u003cp\u003eData regarding wound infection were reported by 13 studies in 2193 patients (1104 vs 1089). No significant difference was detected (RR=1.068, P=0.781)\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePneumonia\u003c/p\u003e\n\u003cp\u003eEleven studies reported pneumonia in 1935 patients (975 vs 960). The results showed no significant difference between the 2 groups (RR=0.799, P=0.282)\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCardiovascular Disease\u003c/p\u003e\n\u003cp\u003eWe combined the mentioned symptoms, such as tachycardia, arrhythmia, myocardial infarction together as cardiovascular complications. And there was no significant difference between the two groups (RR=1.278, P=0.324).\u003c/p\u003e\n\u003cp\u003eUrinary Tract Infection\u003c/p\u003e\n\u003cp\u003eSeven articles considered urinary tract infections and investigated 812 patients (409 vs 403). No significant difference was found between the groups (RR=1.087, P=0.683).\u003c/p\u003e\n\u003cp\u003ePain (Visual analogue scale, VAS)\u003c/p\u003e\n\u003cp\u003eSix studies showed that CHA has lower VAS(WMD = -0.568, P=0.001)\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDeep Vein Thrombosis\u003c/p\u003e\n\u003cp\u003eFive included articles reported deep vein thrombosis in 1174 patients (598 vs 576). There was no significant difference between the two groups (RR=1.050, P=0.910).\u003c/p\u003e\n\u003cp\u003ePressure Injury\u003c/p\u003e\n\u003cp\u003eFive trials reported pressure injury in 1069 patients (530 vs 529). The results showed that UCHA carried a higher risk of pressure injury event (RR=0.432, P=0.014).\u003c/p\u003e\n\u003cp\u003ePulmonary Embolism\u003c/p\u003e\n\u003cp\u003eFive trials reported pulmonary embolism in 1160 patients (590 vs 570). The rate of pulmonary embolism was higher in CHA group but the difference was not significant (RR=2.556, P=0.063).\u003c/p\u003e\n\u003cp\u003eRenal Failure\u003c/p\u003e\n\u003cp\u003eRenal failure was measured in 4 enrolled studies. The result suggested that there was no difference (RR= 0.972, P=0.954)\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGastric Bleeding\u003c/p\u003e\n\u003cp\u003eFour studies provided information on gastric bleeding. The limited data showed no significant difference (RR=1.382, P=0.614)\u003cstrong\u003e .\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHematoma\u003c/p\u003e\n\u003cp\u003eNo significant difference was found regarding hematoma (RR=1.836, P=0.287)\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMental Status Change\u003c/p\u003e\n\u003cp\u003eNo significant difference was found (RR=0.862, P=0.476)\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOperative Outcomes \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSurgery Length\u003c/p\u003e\n\u003cp\u003eNineteen studies reported the operative duration. It was longer in the CHA group (WMD=8.739, P\u0026lt;0.00001).\u003c/p\u003e\n\u003cp\u003eBlood loss\u003c/p\u003e\n\u003cp\u003eThis parameter was measured by 15 studies in 2277 people (CHA, 1142; UCHA, 1135). There was no significant difference(WMD=26.218mL, P=0.085), but the results should be considered carefully due to the high heterogeneity (P\u0026lt;0.0001, I\u003csup\u003e2\u003c/sup\u003e=80.4%) .\u003c/p\u003e\n\u003cp\u003eHospital Length\u003c/p\u003e\n\u003cp\u003eThe length of hospital stay was described by 10 studies including 1450 patients. CHA has shorter overall length of hospital stay, although there was no significant difference(WMD=-0.330, P=0.279).\u003c/p\u003e\n\u003cp\u003eBlood Transfusion\u003c/p\u003e\n\u003cp\u003eThe pooled effect of 6 RCTs (n= 1682) did not favour either of the two groups in terms of blood transfusion (RR=1.000, P=0.999).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMortality\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results showed no significant differences between the CHA and UCHA groups for mortality within, within 6 months, and after 2 years. However, the mortality was slightly higher at one year in UCHA group\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eHip function\u003c/p\u003e\n\u003cp\u003eBarenius[17] found hip function recovery was better in the CHA group in the short term but it deteriorated over time, with no statistically significant difference at 48 months. Khorami[24] and Li[39] described the HHS grade with no specific numbers, so we excluded their data. Taylor[36] used the Oxford hip score (OHS) to assess hip function and concluded that the results were poorer in the UCHA group at 6 weeks, which is in agreement with the result reported by Singh[33]. The OHS is a validated instrument for assessing the outcome of hip replacement based on patient perception in terms of hip pain and function. Since the grouping is arbitrary and is not suggested by the originators of the OHS, we did not synthesize the data from studies using these instruments. DeAngelis[18] collected information about hip function using the Instrumental Activities of Daily Living and Physical Activities of Daily Living scales and the Energy/Fatigue Scale Instruments. The results showed no statistically significant difference in functional outcomes[18]. Parker[15] measured each patient\u0026rsquo;s walking ability using a mobility scale adapted from a hip fracture mobility score and found that patients in the CHA group regained a better degree of mobility at 1 year. His study, performed 10 years ago, also found better scores for 3 of 16 activities of daily living in the CHA group[29]. Moroni\u0026rsquo;s[28] study is different from most other studies, and we found that one possible reason may be that the implants he used were Furlong prostheses coated with HA. The outcomes obtained with the Furlong prosthesis may be due to the advantages of the HA coating in binding with osteoporotic bone, thus establishing stable fixation in patients[28]. Santini[31] used the total functional score (ranging from 0 to 18 points) to evaluate walking ability and personal daily activity. There was no difference regarding the total functional score[31]. Sonne-holm[40] assessed hip function according to pain, gait function, and hip mobility on a scale of 0-6. CHA yielded significantly better results at 3 and 6 months, but after 1 year, approximately 40% of all patients had normal gait function. Emery and Dorr also described similar results in that patients treated with CHA showed a better ability to walk[20,19]. Due to the loss of patients over the long follow-up in Lanslet\u0026rsquo;s study, their results showing that the HHS favoured the uncemented group should be interpreted cautiously[25].\u003c/p\u003e\n\u003cp\u003eIt was difficult to pool data from previous studies due to the inconsistency of the outcome parameters. Therefore, we used the HHS score as a standard parameter with a large sample and confirmed that CHA led to better hip function up to 12 months, with no difference thereafter. The reason may be that bone cement forms a solid bond between the stem and bone, providing favourable biomechanical advantages, further reducing the degree of early postoperative pain, and leading to better mobility and early mobilization. Limited long-term follow-up trials were included in our analysis, and we suggest that future studies should enrol more long-term follow-up trials.\u003c/p\u003e\n\u003cp\u003eProthesis-related complications\u003c/p\u003e\n\u003cp\u003eThe increased occurrence of prosthesis-related complications is highly suspected as the reasons for the greater pain and inferior hip function recovery in UCHA, generating a vicious cycle of worse outcomes in patients. Large database as reports from the Norwegian hip fracture register show a doubling need for secondary surgery in UCHA. Our study is in favour of previous registry outcomes and found that the rates of refracture, loosening or subsidence, and revision were obviously lower in the CHA group.\u003c/p\u003e\n\u003cp\u003eAccording to Vidovic, one of the possible reasons for these results may be that patients in CHA group get improved function and weight-bearing (higher HHS) and can promote bone formation thus had lower periprosthetic bone loss[37]. Another reason for prosthesis-related complications is more in CHA may be that when surgeons use press-fitting to place uncemented stems, accidental fracture during insertion or broaching can occur. Some new uncemented stems have been used in several studies and proven to yield better results. Song[41] pointed out that higher refracture rates are associated with the use of modern uncemented stems compared to cemented stems in FNF. These complications still exist despite the evolving designs and materials[10]. Our results also supported these points.\u003c/p\u003e\n\u003cp\u003eWe recommend that new materials should be considered in combination with patients' conditions, such as canals or bone quality. Technically, the procedure should yield tight contact between the prosthesis and the endosteal bone surface through careful steps during the surgery and without the use of brutal force.\u003c/p\u003e\n\u003cp\u003eCommon complications\u003c/p\u003e\n\u003cp\u003ePressure Injury\u003c/p\u003e\n\u003cp\u003eA significant difference was revealed regarding pressure injury, which was not found by previous studies. This suggests that our meta-analysis achieved greater power in detecting significant differences. Interestingly, cardiovascular complications were similar between groups in our study, which is contrary to the widely accepted view that CHA is associated with higher vascular complications. This may be explained by the prevailing idea of enhanced recovery after surgery and the large number of surgeons who are now mobilizing patients early.\u003c/p\u003e\n\u003cp\u003eOur study shows that pneumonia and urinary tract infection occurred less frequently in the CHA group, with no statistically significant difference. This is consistent with Yoon\u0026rsquo;s[42] conclusion. This may be due to early ambulation or early urinary catheter removal in the CHA group[42].\u003c/p\u003e\n\u003cp\u003ePain\u003c/p\u003e\n\u003cp\u003ePostoperative pain may hinder patients from weight-bearing, disturbing bone mass recovery and function regain [37]. In previous studies, pain was less common in the CHA group, but the incidence differed [15,12]. Of the 24 included RCTs, some recorded patients with pain or without pain; some used the visual analogue scale (VAS) score or the HHS pain sub-score to evaluate pain. After pooling the data, we found lower VAS score in the CHA group.\u003c/p\u003e\n\u003cp\u003eOperative outcomes\u003c/p\u003e\n\u003cp\u003eOur results demonstrate that CHA was associated with a significantly prolonged operative duration (WMD=8.739minutes, p\u0026lt;0.0001), which is consistent with the results of other studies. This finding is probably partly due to the waiting periods required for cement polymerization, insertion and solidification.\u003c/p\u003e\n\u003cp\u003eThere was no difference in the volume of blood loss or the length of hospital stay. These results may be due to earlier mobilization after CHA than UCHA, thus reducing the hospital time. However, it is not clear whether these patients still go to nursing homes or other rehabilitation facilities for recovery, and the lack of recorded data may cause confusion. However, due to the ways used in different areas in measuring blood loss, we can not analysis the high heterogeneity and the results should be explained carefully. What should be noted is that the blood transfusion requirement is similar within groups, and it remind us it may be less important to care for the intraoperative blood loss.\u003c/p\u003e\n\u003cp\u003eMortality\u003c/p\u003e\n\u003cp\u003eWhether CHA has a higher mortality rate than UCHA has long been debated. Kumar[8] reported that CHA had higher 1-year mortality, while Kristensen[6] showed that there was no difference. Our study shows that the mortality rate lower at 1 year postoperatively in CHA group, which is consistent with mainstream previous reports[5,7,43].\u003c/p\u003e\n\u003cp\u003eCHA can lead to death due to bone cement implantation syndrome (BCIS), which occurs at a rate of approximately 0.5%~0.6%[15]. The latest RCT reported 3 deaths that may have been caused by BCIS [15], and Moerman also reported one death possible caused by it[26]. Similar events have been reported by other trials, as well as Australian joint replacement registry[23,21,44]. Movrin[16] noted that there were 8 (10.1%) events of an intraoperative drop in the oxygen saturation (SaO2) in the CHA group, which may have been the reason for BCIS. In a cohort study, Costain[45] et al found a significant difference in the one-day mortality rate, at 0.5% in the UCHA group and 0.8% in the CHA group (p \u0026lt; 0.001)[8]. Two large studies of over 20,000 patients each showed that perioperative death was significantly increased in CHA due to BCIS[46,47]. Regarding long-term effects, Ekman holds the view that greater mortality in the longer term after CHA is related to comorbidities[43]. Both surgeons and anaesthesiologists should consider patients\u0026rsquo; intraoperative blood pressure and oxygen saturation. Thus, we suggest that surgeons determine the best type of surgical procedure based on each patient\u0026rsquo;s own conditions, including physiology, morbidities and cardiovascular condition and follow the guidelines of management of BCIS.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis meta-analysis demonstrates that CHA has better hip function, lower rates of refracture, subsidence or loosening, revision, VAS scores, pressure injury event and one-year mortality than UCHA; UCHA had shorter operative duration.\u003c/p\u003e\n\u003cp\u003eWe believe we are by far the first study enrolled the largest number of RCTs and included the most details of modern implants and traditional ones. We firmly believe our conclusion is stable and reliable.\u003c/p\u003e\n\u003cp\u003eOur study also has several limitations. We did not exclude studies based on criteria such as the implant type (e.g., unipolar or bipolar), patient age, or stem design (e.g., modern or traditional). The latter makes our study generalizable to all elderly patients treated with hemiarthroplasty.\u003c/p\u003e"},{"header":"List Of Abbreviations","content":"\u003cp\u003eRCTs: Randomized controlled trials; CHA: Cemented hemiarthroplasty; UCHA: Uncemented hemiarthroplasty; FNF: Femoral neck fracture; WMD: Weight mean deviation; CI: Confidence interval; RR: Risk ratio; HHS: Harris hip score; VAS: Visual analogue scale; OHS: Oxford hip score; Bone cement implantation syndrome: BCIS\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis meta-analysis and all the included studies meet all the ethical standards described in the declaration of Helsinki. No ethical committee approval was required for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have stated for consents of publications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was available for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTXM conceived the methods of the study, performed the database search, the article selection and data extraction processes, performed the statistical analysis and drafted the manuscript. WD conceived the methods of the study, performed the database search, the article selection and data extraction processes, and drafted the manuscript. NN conceived the methods of the study, helped with the data extraction process, and drafted the manuscript. LY, CJL, LPF, and ZZZ helped to draft the manuscript. All authors read and approved the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGullberg B, Johnell O, Kanis JA (1997) World-wide projections for hip fracture. Osteoporosis International 7 (5):407-413. doi:10.1007/pl00004148\u003c/li\u003e\n\u003cli\u003eFoss NB, Kehlet H (2005) Mortality analysis in hip fracture patients: implications for design of future outcome trials. Br J Anaesth 94 (1):24-29. doi:10.1093/bja/aei010\u003c/li\u003e\n\u003cli\u003eHernlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jonsson B, Kanis JA (2013) Osteoporosis in the European Union: medical management, epidemiology and economic burden. Archives of Osteoporosis 8 (1-2). doi:10.1007/s11657-013-0136-1\u003c/li\u003e\n\u003cli\u003eHansson S, Bulow E, Garland A, Karrholm J, Rogmark C (2020) More hip complications after total hip arthroplasty than after hemi-arthroplasty as hip fracture treatment: analysis of 5,815 matched pairs in the Swedish Hip Arthroplasty Register. Acta orthopaedica 91 (2):133-138. doi:10.1080/17453674.2019.1690339\u003c/li\u003e\n\u003cli\u003eAlisi MS, Al-Alajlouni J, Hammad Y, Mousa K, Elifranji Z, Alaqrabawi I, Al-Saber M, Alsousi A, Elessi K (2020) Management of hip fractures among elderly patients at Jordan University Hospital: A cross-sectional study. Current Orthopaedic Practice 31 (3):231-239. doi:10.1097/bco.0000000000000862\u003c/li\u003e\n\u003cli\u003eKristensen TB, Dybvik E, Kristoffersen M, Dale H, Engesaeter LB, Furnes O, Gjertsen JE (2020) Cemented or Uncemented Hemiarthroplasty for Femoral Neck Fracture? Data from the Norwegian Hip Fracture Register. Clin Orthop Relat Res 478 (1):90-100. doi:10.1097/corr.0000000000000826\u003c/li\u003e\n\u003cli\u003eLin FF, Chen YF, Chen B, Lin CH, Zheng K (2019) Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: A meta-analysis of randomized controlled trails. Medicine 98 (8):e14634. doi:10.1097/md.0000000000014634\u003c/li\u003e\n\u003cli\u003eKumar P, Rajnish RK, Neradi D, Kumar V, Agarwal S, Aggarwal S (2019) Hemiarthroplasty for neck of femur fractures: to cement or not? A systematic review of literature and meta-analysis. European journal of orthopaedic surgery \u0026amp; traumatology : orthopedie traumatologie 29 (4):731-746. doi:10.1007/s00590-019-02364-z\u003c/li\u003e\n\u003cli\u003eImam MA, Shehata MSA, Elsehili A, Morsi M, Martin A, Shawqi M, Grubhofer F, Chirodian N, Narvani A, Ernstbrunner L (2019) Contemporary cemented versus uncemented hemiarthroplasty for the treatment of displaced intracapsular hip fractures: a meta-analysis of forty-two thousand forty-six hips. International orthopaedics 43 (7):1715-1723. doi:10.1007/s00264-019-04325-x\u003c/li\u003e\n\u003cli\u003eVeldman HD, Heyligers IC, Grimm B, Boymans TA (2017) Cemented versus cementless hemiarthroplasty for a displaced fracture of the femoral neck: a systematic review and meta-analysis of current generation hip stems. Bone Joint J 99-b (4):421-431. doi:10.1302/0301-620x.99b4.Bjj-2016-0758.R1\u003c/li\u003e\n\u003cli\u003eNing GZ, Li YL, Wu Q, Feng SQ, Li Y, Wu QL (2014) Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: an updated meta-analysis. European journal of orthopaedic surgery \u0026amp; traumatology : orthopedie traumatologie 24 (1):7-14. doi:10.1007/s00590-012-1151-4\u003c/li\u003e\n\u003cli\u003eLi T, Zhuang Q, Weng X, Zhou L, Bian Y (2013) Cemented versus uncemented hemiarthroplasty for femoral neck fractures in elderly patients: a meta-analysis. PloS one 8 (7):e68903. doi:10.1371/journal.pone.0068903\u003c/li\u003e\n\u003cli\u003eAhn J, Man LX, Park S, Sodl JF, Esterhai JL (2008) Systematic review of cemented and uncemented hemiarthroplasty outcomes for femoral neck fractures. Clin Orthop Relat Res 466 (10):2513-2518. doi:10.1007/s11999-008-0368-3\u003c/li\u003e\n\u003cli\u003eLi N, Zhong L, Wang C, Xu M, Li W (2020) Cemented versus uncemented hemi-arthroplasty for femoral neck fractures in elderly patients: A systematic review and meta-analysis of randomized controlled trials. Medicine 99 (8):e19039. doi:10.1097/md.0000000000019039\u003c/li\u003e\n\u003cli\u003eParker MJ, Cawley S (2020) Cemented or uncemented hemiarthroplasty for displaced intracapsular fractures of the hip: a randomized trial of 400 patients. Bone Joint J 102-b (1):11-16. doi:10.1302/0301-620x.102b1.Bjj-2019-1041.R1\u003c/li\u003e\n\u003cli\u003eMovrin I (2020) Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: A randomized controlled trial with two years follow-up. Acta orthopaedica et traumatologica turcica 54 (1):83-88. doi:10.5152/j.aott.2020.01.432\u003c/li\u003e\n\u003cli\u003eBarenius B, Inngul C, Alagic Z, Enocson A (2018) A randomized controlled trial of cemented versus cementless arthroplasty in patients with a displaced femoral neck fracture: a four-year follow-up. Bone Joint J 100-b (8):1087-1093. doi:10.1302/0301-620x.100b8.Bjj-2017-1593.R1\u003c/li\u003e\n\u003cli\u003eDeangelis JP, Ademi A, Staff I, Lewis CG (2012) Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: a prospective randomized trial with early follow-up. Journal of orthopaedic trauma 26 (3):135‐140. doi:10.1097/BOT.0b013e318238b7a5\u003c/li\u003e\n\u003cli\u003eDorr LD, Glousman R, Hoy AL, Vanis R, Chandler R (1986) Treatment of femoral neck fractures with total hip replacement versus cemented and noncemented hemiarthroplasty. The Journal of arthroplasty 1 (1):21-28. doi:10.1016/s0883-5403(86)80006-7\u003c/li\u003e\n\u003cli\u003eEmery RJ, Broughton NS, Desai K, Bulstrode CJ, Thomas TL (1991) Bipolar hemiarthroplasty for subcapital fracture of the femoral neck. A prospective randomised trial of cemented Thompson and uncemented Moore stems. The Journal of bone and joint surgery British volume 73 (2):322-324\u003c/li\u003e\n\u003cli\u003eFigved W, Opland V, Frihagen F, Jervidalo T, Madsen JE, Nordsletten L (2009) Cemented versus Uncemented Hemiarthroplasty for Displaced Femoral Neck Fractures. Clinical Orthopaedics and Related Research 467 (9):2426-2435. doi:10.1007/s11999-008-0672-y\u003c/li\u003e\n\u003cli\u003eHongpu Z (2012) Cement and non-cement dual cups in the treatment of femoral neck fractures in the elderly. Orthopedic Journal of China 20 (12)\u003c/li\u003e\n\u003cli\u003eInngul C, Blomfeldt R, Ponzer S, Enocson A (2015) Cemented versus uncemented arthroplasty in patients with a displaced fracture of the femoral neck: a randomised controlled trial. The bone \u0026amp; joint journal 97‐B (11):1475‐1480. doi:10.1302/0301-620X.97B11.36248\u003c/li\u003e\n\u003cli\u003eKhorami M, Arti H, Aghdam AA (2016) Cemented versus uncemented hemiarthroplasty in patients with displaced femoral neck fractures. Pak J Med Sci 32 (1):44-48. doi:10.12669/pjms.321.8461\u003c/li\u003e\n\u003cli\u003eLangslet E, Frihagen F, Opland V, Madsen JE, Nordsletten L, Figved W (2014) Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: 5-year followup of a randomized trial. Clin Orthop Relat Res 472 (4):1291-1299. doi:10.1007/s11999-013-3308-9\u003c/li\u003e\n\u003cli\u003eMoerman S, Mathijssen NMC, Niesten DD, Riedijk R, Rijnberg WJ, Koeter S, Kremers van de Hei K, Tuinebreier WE, Molenaar TL, Nelissen R, Vochteloo AJH (2017) More complications in uncemented compared to cemented hemiarthroplasty for displaced femoral neck fractures: a randomized controlled trial of 201 patients, with one year follow-up. BMC musculoskeletal disorders 18 (1)\u003c/li\u003e\n\u003cli\u003eMohabey AV, Warjukar PR, Ravikumar M (2017) Functional outcome of cemented versus uncemented modular bipolar hemiarthroplasty in proximal femoral neck fractures. International Journal of Orthopaedics Sciences 3 (4i):609-611. doi:10.22271/ortho.2017.v3.i4i.83\u003c/li\u003e\n\u003cli\u003eMoroni A, Pegreffi F, Romagnoli M, Hoang-Kim A, Tesei F, Giannini S (2009) Results in osteoporotic femoral neck fractures treated with cemented vs uncemented hip arthroplasty. Journal of bone and joint surgery - british volume 91-B (SUPP_I):167\u003c/li\u003e\n\u003cli\u003eParker MI, Pryor G, Gurusamy K (2010) Cemented versus uncemented hemiarthroplasty for intracapsular hip fractures: A randomised controlled trial in 400 patients. The Journal of bone and joint surgery British volume 92 (1):116-122. doi:10.1302/0301-620x.92b1.22753\u003c/li\u003e\n\u003cli\u003eQi G (2017) Contrast of effect and prognosis of artificial hip joint maken by biomaterials and bone-cement for femoral neck fracture. Orthopaedic Biomechanics Materials and Clinical Study 14 (01):53-55+60. doi:10.3969/j.issn.1672.2017.01.014\u003c/li\u003e\n\u003cli\u003eSantini S, Rebeccato A, Bolgan I, Turi G (2005) Hip fractures in elderly patients treated with bipolar hemiarthroplasty: comparison between cemented and cementless implants. Journal of orthopaedics and traumatology 6 (2):80-87\u003c/li\u003e\n\u003cli\u003eShenqi P (2013) Comparison of the efficacy of bone cement type and non-bone cement type hemihip replacement for displaced femoral neck fracture. Chinese Journal of Postgraduates of Medicine 36 (17):41-43. doi:10.3760/cma.j.issn.1673-4904.2013.17.015\u003c/li\u003e\n\u003cli\u003eSingh GK, Deshmukh RG (2006) Uncemented Austin-Moore and cemented Thompson unipolar hemiarthroplasty for displaced fracture neck of femur--comparison of complications and patient satisfaction. Injury 37 (2):169-174. doi:10.1016/j.injury.2005.09.016\u003c/li\u003e\n\u003cli\u003eSonne-Holm S, Walter S, Jensen JS (1982) Moore hemi-arthroplasty with and without bone cement in femoral neck fractures. A clinical controlled trial. Acta orthopaedica Scandinavica 53 (6):953-956. doi:10.3109/17453678208992854\u003c/li\u003e\n\u003cli\u003eTalsnes O, Hjelmstedt F, Pripp AH, Reiker\u0026aring;s O, Dahl OE (2013) No difference in mortality between cemented and uncemented hemiprosthesis for elderly patients with cervical hip fracture. A prospective randomized study on 334 patients over 75 years. Archives of orthopaedic and trauma surgery 133 (6):805‐809. doi:10.1007/s00402-013-1726-5\u003c/li\u003e\n\u003cli\u003eTaylor F, Wright M, Zhu M (2012) Hemiarthroplasty of the hip with and without cement: a randomized clinical trial. Journal of bone and joint surgery American volume 94 (7):577‐583. doi:10.2106/JBJS.K.00006\u003c/li\u003e\n\u003cli\u003eVidovic D, Punda M, Darabos N, Bekavac-Beslin M, Bakota B, Matejcic A (2015) Regional bone loss following femoral neck fracture: A comparison between cemented and cementless hemiarthroplasty. Injury 46 Suppl 6:S52-56. doi:10.1016/j.injury.2015.10.069\u003c/li\u003e\n\u003cli\u003eXingwang L (2017) Comparison of the efficacy of cement and non-cement bone in the treatment of femoral neck fractures in the elderly. Contemporary Medicine 23 (No.464). doi:doi:10.3969/j.\u003c/li\u003e\n\u003cli\u003eJianguo L (2017) comparison of the effects and complications f biotype and cement-based artificial hip prsthesis in the treatment of femoral neck fracture in the elderly. Clinical Medicine of China 33 (12)\u003c/li\u003e\n\u003cli\u003eSonne-Holm S, Walter S, Jensen JS (1982) Moore hemi-arthroplasty with and without bone cement in femoral neck fractures. A clinical controlled trial. Acta orthopaedica Scandinavica 53 (6):953-956\u003c/li\u003e\n\u003cli\u003eSong JSA, Dillman D, Wilson D, Dunbar M, Richardson G (2019) Higher periprosthetic fracture rate associated with use of modern uncemented stems compared to cemented stems in femoral neck fractures. Hip international : the journal of clinical and experimental research on hip pathology and therapy 29 (2):177-183. doi:10.1177/1120700018772291\u003c/li\u003e\n\u003cli\u003eYoon BH, Seo JG, Koo KH (2017) Comparison of Postoperative Infection-Related Complications between Cemented and Cementless Hemiarthroplasty in Elderly Patients: A Meta-Analysis. Clin Orthop Surg 9 (2):145-152. doi:10.4055/cios.2017.9.2.145\u003c/li\u003e\n\u003cli\u003eEkman E, Laaksonen I, Isotalo K, Liukas A, Vahlberg T, Makela K (2019) Cementing does not increase the immediate postoperative risk of death after total hip arthroplasty or hemiarthroplasty: a hospital-based study of 10,677 patients. Acta orthopaedica 90 (3):270-274. doi:10.1080/17453674.2019.1596576\u003c/li\u003e\n\u003cli\u003eKristensen T, Dybvik E, Kristoffersen M, Engesaeter L, Furnes O, Gjertsen J-E (2019) Cemented or Uncemented Hemiarthroplasty for Femoral Neck Fracture? Data from the Norwegian Hip Fracture Register. Clinical Orthopaedics and Related Research 478. doi:10.1097/CORR.0000000000000826\u003c/li\u003e\n\u003cli\u003eCostain DJ, Whitehouse SL, Pratt NL, Graves SE, Ryan P, Crawford RW (2011) Perioperative mortality after hemiarthroplasty related to fixation method. Acta orthopaedica 82 (3):275-281. doi:10.3109/17453674.2011.584208\u003c/li\u003e\n\u003cli\u003eCostain DJ, Whitehouse SL, Pratt NL, Graves SE, Ryan P, Crawford RW (2011) Perioperative mortality after hemiarthroplasty related to fixation method. Acta orthopaedica 82 (3):275-281. doi:10.3109/17453674.2011.584208\u003c/li\u003e\n\u003cli\u003eMiddleton R, Uzoigwe C, Young P, Smith R, Gosal H, Holt G (2014) Peri-operative mortality after hemiarthroplasty for fracture of the hip DOES CEMENT MAKE A DIFFERENCE? The bone \u0026amp; joint journal 96-B:1185-1191. doi:10.1302/0301-620X.96B9.33935\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1 Characteristics of the included studies\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" width=\"0\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cbr /\u003e\n\u003cp\u003e\u003cstrong\u003eStudies\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u003cstrong\u003ePeriod\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCH/UCHA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003emale/female\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u003cstrong\u003eBipolar/\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eunipolar\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e\u003cstrong\u003eNumber\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCH/UCHA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u003cstrong\u003eASA\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(1,2/3,4)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(Mean \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eScore)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"97\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurgeon\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"4\" width=\"174\"\u003e\n\u003cp\u003e\u003cstrong\u003eImplants type\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCH/UCHA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u003cstrong\u003eFollow-up\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"62\"\u003e\n\u003cp\u003e\u003cstrong\u003eSurgical \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eapproach\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003eBarenius2018\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e[3]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e2009.10-2013.04\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e81.2(8.95)/81.3(7.81)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e41/99\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003ea\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e67/74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e67/141\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"97\"\u003e\n\u003cp\u003e14 OS\u003c/p\u003e\n\u003cp\u003e(Experienced)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"165\"\u003e\n\u003cp\u003eCemented Unipolar Exeter stem\u003csup\u003e1\u003c/sup\u003e/Uncemented Unipolar Hydroxyapatite-coated Bimetric stem\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"96\"\u003e\n\u003cp\u003e24m/48m\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"79\"\u003e\n\u003cp\u003eDLA\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003eDeAngelis2012\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e[5]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e2005.03-2008.05\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e81.8(9.0)/\u003c/p\u003e\n\u003cp\u003e82.8(7.6)\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e30/100\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003ea\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e66/64\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e110/20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"97\"\u003e\n\u003cp\u003eOS\u003c/p\u003e\n\u003cp\u003e(Attending)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"165\"\u003e\n\u003cp\u003eCemented Unipolar Femoral Prosthesis\u003csup\u003e3\u003c/sup\u003e/Uncemented Unipolar Component\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"96\"\u003e\n\u003cp\u003e1m/2m/1y\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"79\"\u003e\n\u003cp\u003eSA/PA\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003eDorr1986\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e[6]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e1980.03-1982.07\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e72（10.390/\u003c/p\u003e\n\u003cp\u003e66(12.73)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e15/35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003eb\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e37/13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"97\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"165\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"96\"\u003e\n\u003cp\u003e2 to 4 year\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"79\"\u003e\n\u003cp\u003ePA\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003eEmery1991\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e[8]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003eunclear\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e78(7.2)/\u003c/p\u003e\n\u003cp\u003e79.6(8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e7/46\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003eb\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e27/26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"97\"\u003e\n\u003cp\u003eJunior OS\u003c/p\u003e\n\u003cp\u003e(Same group)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"165\"\u003e\n\u003cp\u003eThompson\u003csup\u003e5\u003c/sup\u003e /Austin Moore\u003csup\u003e5\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"96\"\u003e\n\u003cp\u003e24m\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"79\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003eFigved2009\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e[9]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e2004.09-2006.08\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e83.4(5.68)/83.0(6.29)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e53/167\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003eb\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e112/108\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e94/126\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"97\"\u003e\n\u003cp\u003eOS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"165\"\u003e\n\u003cp\u003eSpectron TM\u003csup\u003e6\u003c/sup\u003e / Corail-1\u003csup\u003e7\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"96\"\u003e\n\u003cp\u003e3m/12m\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"79\"\u003e\n\u003cp\u003ePA\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003eGuo2017\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e[33]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e2010.06-2014.12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e66.2(15.8)/\u003c/p\u003e\n\u003cp\u003e68.7(16.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e59/41\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e50/50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"97\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"165\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"96\"\u003e\n\u003cp\u003e2w/4w/3m/12m\u003c/p\u003e\n\u003cp\u003eUp to 1 year\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"79\"\u003e\n\u003cp\u003eMPA\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003eInngul2015\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e[16]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e2009.10-2013.04\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e81.2(8.95)/81.3(7.81)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e41/99\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003ea\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e67/74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e67/141\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"97\"\u003e\n\u003cp\u003e14 OS\u003c/p\u003e\n\u003cp\u003e(Experienced)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"165\"\u003e\n\u003cp\u003eCemented Unipolar Exeter stem\u003csup\u003e1\u003c/sup\u003e/Uncemented Unipolar Hydroxyapatite-coated Bimetric stem\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"96\"\u003e\n\u003cp\u003e4m/12m\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"79\"\u003e\n\u003cp\u003eDLA\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003eKhorami2016\u003c/strong\u003e[18]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e2011-2012\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e79(6.38)/71.7(3.19)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e19/32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003eb\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e22/29\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"97\"\u003e\n\u003cp\u003eOS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"165\"\u003e\n\u003cp\u003e\u0026nbsp;Bipolar Zimmer femoral\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"96\"\u003e\n\u003cp\u003e1m/6m\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"79\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003eLangslet2014\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e[21]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e2004.09-2006.08\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e83.4(5.68)/83.0(6.29)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e53/167\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003eb\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e112/108\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e94/126\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"97\"\u003e\n\u003cp\u003eOS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"165\"\u003e\n\u003cp\u003eSpectron TM\u003csup\u003e6\u003c/sup\u003e / Corail-1\u003csup\u003e7\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"96\"\u003e\n\u003cp\u003e5y\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"79\"\u003e\n\u003cp\u003ePA\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003eLi2017\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e[17]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e2013.10-2015.10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e70.2(2.4)/\u003c/p\u003e\n\u003cp\u003e69.6(2.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e36/79\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e40/39\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"5\" width=\"123\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"139\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"105\"\u003e\n\u003cp\u003e3m/6m/12m\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"70\"\u003e\n\u003cp\u003ePA\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003eMoerman2017\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e[25]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e2008.08-2012.06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e84(6.7)/83(6.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e58/143\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003ea\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e110/91\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e135/66\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"5\" width=\"123\"\u003e\n\u003cp\u003eOrthopedic surgeon/Registrar\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"139\"\u003e\n\u003cp\u003eCemented M\u0026uuml;ller Straight Stem\u003csup\u003e8\u003c/sup\u003e/Uncemented DB-10\u003csup\u003e9\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"105\"\u003e\n\u003cp\u003e12m\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"70\"\u003e\n\u003cp\u003eLA/PA/SA\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003eMohabey2017\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e[26]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e2014.09-2015.12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e70.03(11.55)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e18/22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003eb\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e20/20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"5\" width=\"123\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"139\"\u003e\n\u003cp\u003eCemented modular/Uncemented modular bipolar\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"105\"\u003e\n\u003cp\u003e6m\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"70\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003eMoroni2018\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e[27]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e75(5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e0/40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003ea\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e22/18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"5\" width=\"123\"\u003e\n\u003cp\u003eOS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"139\"\u003e\n\u003cp\u003eAHS prosthesis/HA-coated Furlong prosthesis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"105\"\u003e\n\u003cp\u003e3y\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"70\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003eMovrin2020\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e[28]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e2013.01-2015.12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e86(5)/\u003c/p\u003e\n\u003cp\u003e84(4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e64/94\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003eb\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e79/79\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e86/72\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"5\" width=\"123\"\u003e\n\u003cp\u003e9 consultants/specialist orthopedic trauma surgeons\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"139\"\u003e\n\u003cp\u003emodular bipolar prosthesis, 80-mg Palacos cement\u003csup\u003e10\u003c/sup\u003e / uncemented modular bipolar\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"105\"\u003e\n\u003cp\u003e6w/3m/6m/12m/24m\u003c/p\u003e\n\u003cp\u003eUp to 2years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"70\"\u003e\n\u003cp\u003eSA\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003eParker2020\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e[31]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e2013.08-2018.06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e77.1(8.4)/\u003c/p\u003e\n\u003cp\u003e77.1(6.35)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e127/277\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003ea\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e200/200\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e71/329\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"5\" width=\"123\"\u003e\n\u003cp\u003eLead trialist\u003c/p\u003e\n\u003cp\u003e(MJP)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"139\"\u003e\n\u003cp\u003ecemented unipolar double-tapered stem\u003csup\u003e11\u003c/sup\u003e Biomet/ uncemented fully hydroxyapatite-coated Furlong\u003csup\u003e12\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"105\"\u003e\n\u003cp\u003e3m/6m/9m/12m\u003c/p\u003e\n\u003cp\u003eUp to 1 year\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"70\"\u003e\n\u003cp\u003eHDLA\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003eParker2010\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e[30]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e2001.03-2006.11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e83(10.46)/\u003c/p\u003e\n\u003cp\u003e83(12.12)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e92/308\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003ea\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e200/200\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e2.7/2.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"5\" width=\"123\"\u003e\n\u003cp\u003e1 OS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"139\"\u003e\n\u003cp\u003eThompson\u003csup\u003e13\u003c/sup\u003e/Austin-Moore\u003csup\u003e14\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"105\"\u003e\n\u003cp\u003e3m/6m/9m/12m\u003c/p\u003e\n\u003cp\u003eUp to 5 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"70\"\u003e\n\u003cp\u003eSA\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003ePan2013\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e[35]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e2005.10-2011.10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e70.5(5.5)/\u003c/p\u003e\n\u003cp\u003e72.2(7.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e19/61\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e41/39\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"5\" width=\"123\"\u003e\n\u003cp\u003eOS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"139\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"105\"\u003e\n\u003cp\u003e1y\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"70\"\u003e\n\u003cp\u003eRevised Gibson\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003eSingh2005\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e[36]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e1999.01-2000.12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e84/83\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e8/46\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003ea\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e25/29\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"5\" width=\"123\"\u003e\n\u003cp\u003econsultant OS/\u003c/p\u003e\n\u003cp\u003emiddle grade OS/\u003c/p\u003e\n\u003cp\u003eSHO\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"139\"\u003e\n\u003cp\u003eThompson/Austin-Moore\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"105\"\u003e\n\u003cp\u003e6w/3m/6m/9m/12m\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"70\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003eSantini2005\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e[34]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e2000.09-2001.12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e82.09(7.60)/\u003c/p\u003e\n\u003cp\u003e79.68(8.62)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e60/46\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003eb\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e53/53\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e11/105\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"5\" width=\"123\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"139\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"105\"\u003e\n\u003cp\u003e6m/12m\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"70\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003eSonne-Holm1982\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e[38]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e1979\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e37/75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e55/57\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"5\" width=\"123\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"139\"\u003e\n\u003cp\u003eMoore cemented methyl-methacrylate/ Moore uncemented prosthesis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"105\"\u003e\n\u003cp\u003e6w/3m/6m/12m\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"70\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003eTalsnes2013\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e[40]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e2005-2010\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e84.0(5.1)/84.3(5.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e82/252\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e162/172\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e138/196\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"5\" width=\"123\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"139\"\u003e\n\u003cp\u003ebipolar cemented\u003csup\u003e15\u003c/sup\u003e / bipolar non-cemented\u003csup\u003e16\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"105\"\u003e\n\u003cp\u003e12m\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"70\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003eTaylor2013\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e[41]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e2006.05-2008.11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e85.3(7)/85.1(6.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e50/110\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003ea\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e80/80\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"4\" width=\"121\"\u003e\n\u003cp\u003econsultant OS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"141\"\u003e\n\u003cp\u003eCemented modular Exeter stem with an appropriately sized UniTrax head (Stryker)/uncemented Alloclassic stem with an appropriately sized head\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"105\"\u003e\n\u003cp\u003e6w/6m/1y/2y\u003c/p\u003e\n\u003cp\u003eUp to 2 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"70\"\u003e\n\u003cp\u003eHDLA\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003eVidovic2013\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e[43]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e2007.01-2010.12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e82.9(4.63)/82.04(4.32)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e0/79\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003ea\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e38/41\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"70\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"113\"\u003e\n\u003cp\u003e5 OS\u003c/p\u003e\n\u003cp\u003e(Experienced)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"141\"\u003e\n\u003cp\u003eCemented Modular/Cementless Modular Austin Moore\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"105\"\u003e\n\u003cp\u003e3m/6m/12m\u003c/p\u003e\n\u003cp\u003eUp to 1 year\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"70\"\u003e\n\u003cp\u003eDLA\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003eZhao2012\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e[14]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e2008.07-2011.06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e77.03(5.17)/76.34(5.62)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e40/91\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003eb\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e67/64\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"79\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"105\"\u003e\n\u003cp\u003e1 OS group\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"139\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"105\"\u003e\n\u003cp\u003e3m/12m/2y\u003c/p\u003e\n\u003cp\u003eUp to 2 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"70\"\u003e\n\u003cp\u003ePA(Moore)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"79\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"8\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"10\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"25\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"139\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"9\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"9\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"53\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"17\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003col style=\"list-style-type: lower-alpha;\"\u003e\n\u003cli\u003eUnipolar\u003c/li\u003e\n\u003cli\u003eBipolar\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eN/A. not find\u003c/p\u003e\n\u003cp\u003eOS. orthopedic surgeon\u003c/p\u003e\n\u003cp\u003eDLA: direct lateral approach\u003c/p\u003e\n\u003cp\u003eSA: standard anterolateral approach\u003c/p\u003e\n\u003cp\u003ePA: Posterior approach\u003c/p\u003e\n\u003cp\u003eMPA: Modified posterolateral approach\u003c/p\u003e\n\u003cp\u003eHDLA: Hardinge direct lateral approach\u003c/p\u003e\n\u003col\u003e\n\u003cli\u003eStryker, Kalamazoo, Michigan\u003c/li\u003e\n\u003cli\u003eZimmer Biomet, Warsaw, Indiana\u003c/li\u003e\n\u003cli\u003eVerSys LD/Fx; Zimmer, Warsaw, IN\u003c/li\u003e\n\u003cli\u003eVerSys Beaded FullCoat; Zimmer, Warsaw, IN\u003c/li\u003e\n\u003cli\u003eMonk duoplet design (Johnson \u0026amp; Johnson, England)\u003c/li\u003e\n\u003cli\u003eSmith \u0026amp; Nephew, Inc, Memphis, TN\u003c/li\u003e\n\u003cli\u003eDePuy International Ltd, Leeds, UK\u003c/li\u003e\n\u003cli\u003eZimmer - Biomet, 1800 West Center St. Warsaw, Indiana, USA\u003c/li\u003e\n\u003cli\u003eZimmer- Biomet, 1800 West Center St. Warsaw, Indiana, USA\u003c/li\u003e\n\u003cli\u003eHeraeus, Wehrheim, Germany\u003c/li\u003e\n\u003cli\u003eExeter Trauma Stem, Stryker Medical, Michigan, USA, or CPT Zimmer/Biomet, Warsaw, Indiana, USA\u003c/li\u003e\n\u003cli\u003eJRI Orthopaedics, Sheffield, UK\u003c/li\u003e\n\u003cli\u003eStryker/Howmedica Ltd, Newbury, United Kingdom\u003c/li\u003e\n\u003cli\u003eCorin Ltd, Cirencester , United Kingdom\u003c/li\u003e\n\u003cli\u003eLandos Titan, Depuy, Warshaw, IN, USA\u003c/li\u003e\n\u003cli\u003eLandos Corail, Depuy, Warshaw, IN, USA\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 Outcomes of meta-analysis\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" width=\"100%\"\u003e\n\u003ctbody\u003e\n\u003ctr style=\"height: 160px;\"\u003e\n\u003ctd style=\"height: 160px;\" width=\"23%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 160px;\" width=\"10%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eN (study)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 160px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eN (CH)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 160px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eN (UCH)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 160px;\" colspan=\"2\" width=\"26%\"\u003e\n\u003cp\u003ePooled data\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cbr /\u003e\n\u003cp\u003eWMD/RR (95% CI)\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; P\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 160px;\" colspan=\"2\" width=\"19%\"\u003e\n\u003cp\u003eHeterogeneity\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cbr /\u003e\n\u003cp\u003eI\u0026sup2; (%)\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Ph\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"23%\"\u003e\n\u003cp\u003e\u003cstrong\u003eHip Function(HHS)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"10%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"17%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 37px;\"\u003e\n\u003ctd style=\"height: 37px;\" width=\"23%\"\u003e\n\u003cp\u003eHHS（\u0026lt;6 week)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 37px;\" width=\"10%\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 37px;\" width=\"9%\"\u003e\n\u003cp\u003e122\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 37px;\" width=\"9%\"\u003e\n\u003cp\u003e126\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 37px;\" width=\"17%\"\u003e\n\u003cp\u003e9.097(3.034,15.161)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 37px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026lt;0.003*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 37px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp; 75.8%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 37px;\" width=\"9%\"\u003e\n\u003cp\u003e0.042\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 37px;\"\u003e\n\u003ctd style=\"height: 37px;\" width=\"23%\"\u003e\n\u003cp\u003eHHS（3 months)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 37px;\" width=\"10%\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 37px;\" width=\"9%\"\u003e\n\u003cp\u003e291\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 37px;\" width=\"9%\"\u003e\n\u003cp\u003e282\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 37px;\" width=\"17%\"\u003e\n\u003cp\u003e3.347(1.478,5.216)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 37px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026lt;0.0001*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 37px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp; 45.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 37px;\" width=\"9%\"\u003e\n\u003cp\u003e0.119\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 37px;\"\u003e\n\u003ctd style=\"height: 37px;\" width=\"23%\"\u003e\n\u003cp\u003eHHS（6 months)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 37px;\" width=\"10%\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 37px;\" width=\"9%\"\u003e\n\u003cp\u003e98\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 37px;\" width=\"9%\"\u003e\n\u003cp\u003e100\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 37px;\" width=\"17%\"\u003e\n\u003cp\u003e0.217(-5.860,6.294)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 37px;\" width=\"9%\"\u003e\n\u003cp\u003e0.944\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 37px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp; 91.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 37px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 37px;\"\u003e\n\u003ctd style=\"height: 37px;\" width=\"23%\"\u003e\n\u003cp\u003eHHS（12 month)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 37px;\" width=\"10%\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 37px;\" width=\"9%\"\u003e\n\u003cp\u003e375\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 37px;\" width=\"9%\"\u003e\n\u003cp\u003e375\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 37px;\" width=\"17%\"\u003e\n\u003cp\u003e2.183(0.161,4.205)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 37px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp; 0.034*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 37px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp; 39.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 37px;\" width=\"9%\"\u003e\n\u003cp\u003e0.125\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 37px;\"\u003e\n\u003ctd style=\"height: 37px;\" width=\"23%\"\u003e\n\u003cp\u003eHHS（24 to 60 months)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 37px;\" width=\"10%\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 37px;\" width=\"9%\"\u003e\n\u003cp\u003e156\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 37px;\" width=\"9%\"\u003e\n\u003cp\u003e186\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 37px;\" width=\"17%\"\u003e\n\u003cp\u003e0.337(-2.945,3.619)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 37px;\" width=\"9%\"\u003e\n\u003cp\u003e0.840\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 37px;\" width=\"9%\"\u003e\n\u003cp\u003e50.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 37px;\" width=\"9%\"\u003e\n\u003cp\u003e0.037\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"23%\"\u003e\n\u003cp\u003e\u003cstrong\u003eProthesis-related Complications\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"10%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"17%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"23%\"\u003e\n\u003cp\u003eRefracture\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"10%\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e910\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e898\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"17%\"\u003e\n\u003cp\u003e0.227(0.135,0.381)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026lt;0.0001*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.00%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.941\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"23%\"\u003e\n\u003cp\u003eSubsidence or Loosening\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"10%\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e485\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e467\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"17%\"\u003e\n\u003cp\u003e0.295(0.112,0.778)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026lt;0.014*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e49.30%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.061\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"23%\"\u003e\n\u003cp\u003eRevision\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"10%\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e749\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e771\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"17%\"\u003e\n\u003cp\u003e0.468(0.279,0.786)\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.004*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.00%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.781\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"23%\"\u003e\n\u003cp\u003eDislocation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"10%\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e656\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e640\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"17%\"\u003e\n\u003cp\u003e1.036(0.496,2.161)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.926\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.00%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.753\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"23%\"\u003e\n\u003cp\u003eHeterotopic Ossification\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"10%\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e265\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e261\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"17%\"\u003e\n\u003cp\u003e0.983(0.759,1.272)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.894\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.468\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.00%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"23%\"\u003e\n\u003cp\u003eAcetabular Erosion\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"10%\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e189\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e205\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"17%\"\u003e\n\u003cp\u003e1.769(0.400,7.831)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.452\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.229\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e32.10%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"23%\"\u003e\n\u003cp\u003e\u003cstrong\u003eGeneral Complications\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"10%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"17%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"23%\"\u003e\n\u003cp\u003eWound Infection\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"10%\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e1104\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e1089\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"17%\"\u003e\n\u003cp\u003e1.068(0.670,1.703)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.781\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.872\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.00%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"23%\"\u003e\n\u003cp\u003ePneumonia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"10%\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e975\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e960\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"17%\"\u003e\n\u003cp\u003e0.799(0.532,1.202)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.282\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.791\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.00%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"23%\"\u003e\n\u003cp\u003eCardiovascular Disease\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"10%\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e796\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e793\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"17%\"\u003e\n\u003cp\u003e1.278(0.785,2.078)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.324\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.788\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.00%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"23%\"\u003e\n\u003cp\u003eUrinary Tract Infection\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"10%\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e409\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e403\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"17%\"\u003e\n\u003cp\u003e1.087(0.727,1.625)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.683\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.811\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.00%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"23%\"\u003e\n\u003cp\u003eVAS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"10%\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e520\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e525\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"17%\"\u003e\n\u003cp\u003e-0.568(-0.897, -0.239)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.001*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.017\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e63.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"23%\"\u003e\n\u003cp\u003eDeep Vein Thrombosis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"10%\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e598\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e576\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"17%\"\u003e\n\u003cp\u003e1.050(0.452,2.439)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.910\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.876\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.00%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"23%\"\u003e\n\u003cp\u003ePressure Injury\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"10%\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e530\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e529\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"17%\"\u003e\n\u003cp\u003e0.432(0.221, 0.846)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.014*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.802\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.00%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"23%\"\u003e\n\u003cp\u003ePulmonary Embolism\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"10%\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e590\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e570\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"17%\"\u003e\n\u003cp\u003e2.556(0.951,6.870)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.063\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.814\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.00%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"23%\"\u003e\n\u003cp\u003eRenal Failure\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"10%\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e577\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e565\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"17%\"\u003e\n\u003cp\u003e0.972(0.366,2.581)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.954\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.521\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.00%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"23%\"\u003e\n\u003cp\u003eGastric Bleeding\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"10%\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e563\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e544\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"17%\"\u003e\n\u003cp\u003e1.382(0.393,4.869)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.614\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.308\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e16.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"23%\"\u003e\n\u003cp\u003eHematoma\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"10%\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e510\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e491\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"17%\"\u003e\n\u003cp\u003e1.836(0.599,5.622)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.287\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.480\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.00%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"23%\"\u003e\n\u003cp\u003eMental Status Change\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"10%\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e510\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e491\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"17%\"\u003e\n\u003cp\u003e0.862(0.572,1.298)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.476\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.725\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.00%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"23%\"\u003e\n\u003cp\u003e\u003cstrong\u003eOperative Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"10%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"17%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"23%\"\u003e\n\u003cp\u003eSurgery Length\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"10%\"\u003e\n\u003cp\u003e19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e1458\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e1445\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"17%\"\u003e\n\u003cp\u003e8.739(6.354,11.124)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp; \u0026lt;0.0001*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp; 72.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"23%\"\u003e\n\u003cp\u003eBlood Loss\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"10%\"\u003e\n\u003cp\u003e15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e1142\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e1135\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"17%\"\u003e\n\u003cp\u003e26.218(-3.572,56.008)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp; 0.085\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp; 80.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"23%\"\u003e\n\u003cp\u003eHospital Length\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"10%\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e731\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e719\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"17%\"\u003e\n\u003cp\u003e-0.330(-0.927,0.267)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp; 0.279\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp; 9.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.355\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"23%\"\u003e\n\u003cp\u003eRequired Blood Transfusion\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"10%\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e849\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e833\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"17%\"\u003e\n\u003cp\u003e1.000(0.805,1.243)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;0.999\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp; 46%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.099\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"23%\"\u003e\n\u003cp\u003e\u003cstrong\u003eMortality\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"10%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"17%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"23%\"\u003e\n\u003cp\u003e30-day\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"10%\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e762\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e748\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"17%\"\u003e\n\u003cp\u003e1.046(0.703,1.557)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.824\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;0.00%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.663\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"23%\"\u003e\n\u003cp\u003e2 to 6 months\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"10%\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e911\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e822\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"17%\"\u003e\n\u003cp\u003e0.943(0.786, 1.131)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.526\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.00%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.946\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"23%\"\u003e\n\u003cp\u003e1-year\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"10%\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e855\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e834\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"17%\"\u003e\n\u003cp\u003e0.852(0.727,0.998)\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.047*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.00%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.797\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"23%\"\u003e\n\u003cp\u003e2-year\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"10%\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e628\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e628\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"17%\"\u003e\n\u003cp\u003e1.009(0.870,1.171)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.902\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.00%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.936\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"23%\"\u003e\n\u003cp\u003e3 to 5 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"10%\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e667\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e674\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"17%\"\u003e\n\u003cp\u003e1.032(0.970,1.098)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.324\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.00%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"9%\"\u003e\n\u003cp\u003e0.854\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*OR or WMD considered statistically significant (p \u0026lt; 0.05)\u003c/p\u003e\n\u003cp\u003eRR, risk ratio (for dichotomous outcomes); WMD, weighted mean difference (for continuous outcomes); CI, confidence interval; UCH, uncemented hemiarthroplasty; CH, cemented hemiarthroplasty\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hemiarthroplasty, Cemented, Uncemented, Outcomes, Femoral Neck Fractures, Complications","lastPublishedDoi":"10.21203/rs.3.rs-61772/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-61772/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eWe performed an updated systematic review and meta-analysis to compare the outcomes of CHA and UCHA in patients with FNFs.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eWe searched 6 English databases (Cochrane Library, ScienceDirect, PubMed, Embase, Medline, and Web of Science) and 4 Chinese databases (CNKI, VIP, Wang Fang, and Sino Med) in July 2020. The quality of each study was assessed according to the Cochrane handbook of systematic reviews. Data were pooled as risk ratios (RRs) and weighted mean differences (WMDs) with 95% confidence intervals (95% CIs). We used the random-effects model despite the heterogeneity among the studies. Data regarding baseline characteristics, hip function, complications both prosthetic-related and common, and operative outcomes are reported. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eA total of 24 RCTs based on 22 trials involving 3119 patients (CHA, 1575; UCHA, 1544) were included. Patients in CHA group show better hip function with HHS within 6 weeks (WMD=9.097, 95% CI, 3.034-15.161; P\u0026lt;0.003), 3 months (WMD=3.347, 95% CI, 1.478-5.216; P\u0026lt;0.001), 12 months (WMD=2.183, 95% CI, 0.161-4.205; P=0.034). The pooled results show that CHA had lower rates of refracture (RR=0.227, 95% CI, 0.135-0.381; P\u0026lt;0.0001), subsidence or loosening (RR=0.295, 95% CI, 0.112,0.778; P\u0026lt;0.014) and revision (RR=0.468, 95% CI, 0.279-0.786; P=0.004). Furthermore, CHA group tend to have lower pain(VAS score) (WMD=-0.568, 95% CI, -0.897 to -0.239; P=0.001), lower rate of pressure injury(RR=0.432, 95% CI, 0.221-0.846; P=0.014) and mortality at 1 year after surgery(RR=0.852, 95% CI, 0.727-0.998; P=0.047). UCHA showed a shorter operative duration(WMD=8.739, 95% CI, 6.354-11.124; P\u0026lt;0.0001).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThis meta-analysis demonstrates that CHA has better hip function, lower rates of refracture, subsidence or loosening, revision, pressure ulcer, pain and one-year mortality than UCHA, while UCHA has shorter operative duration.\u003c/p\u003e","manuscriptTitle":"Comparison Between Cemented and Uncemented Hemiarthroplasty in Patients With Femoral Neck Fractures: A Systematic Review and Meta-analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2020-09-08 14:53:30","doi":"10.21203/rs.3.rs-61772/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1fda4fbc-1a86-45af-b97e-447ebd4f395d","owner":[],"postedDate":"September 8th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":449595,"name":"Orthopedics"}],"tags":[],"updatedAt":"2021-01-06T15:47:00+00:00","versionOfRecord":[],"versionCreatedAt":"2020-09-08 14:53:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-61772","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-61772","identity":"rs-61772","version":["v1"]},"buildId":"FbvkV6FR0MCFSLy54lSbu","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}