• Miguel A Fernandez, Juul Achten, Nicholas Parsons, Xavier L Griffin, May-Ee Png, Jenny Gould, Alwin McGibbon, Matthew L Costa, and WHiTE 5 Investigators.
• From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom.
• N. Engl. J. Med. 2022 Feb 10; 386 (6): 521-530.

BackgroundControversy exists over the use of bone cement in hip fractures treated with hemiarthroplasty. Only limited data on quality of life after cemented as compared with modern uncemented hemiarthroplasties are available.MethodsWe conducted a multicenter, randomized, controlled trial comparing cemented with uncemented hemiarthroplasty in patients 60 years of age or older with an intracapsular hip fracture. The primary outcome was health-related quality of life measured with the use of utility scores on the EuroQol Group 5-Dimension (EQ-5D) questionnaire at 4 months after randomization (range of scores, -0.594 to 1, with higher scores indicating better quality of life; range for minimal clinically important difference, 0.050 to 0.075).ResultsA total of 610 patients were assigned to undergo cemented hemiarthroplasty and 615 to undergo modern uncemented hemiarthroplasty; follow-up data were available for 71.6% of the patients at 4 months. The mean EQ-5D utility score was 0.371 in patients assigned to the cemented group and 0.315 in those assigned to the uncemented group (adjusted difference, 0.055; 95% confidence interval [CI], 0.009 to 0.101; P = 0.02). The between-group difference at 1 month was similar to that at 4 months, but the difference at 12 months was smaller than that at 4 months. Mortality at 12 months was 23.9% in the cemented group and 27.8% in the uncemented group (odds ratio for death, 0.80; 95% CI, 0.62 to 1.05). Periprosthetic fractures occurred in 0.5% and 2.1% of the patients in the respective groups (odds ratio [uncemented vs. cemented], 4.37; 95% CI, 1.19 to 24.00). The incidences of other complications were similar in the two groups.ConclusionsAmong patients 60 years of age or older with an intracapsular hip fracture, cemented hemiarthroplasty resulted in a modestly but significantly better quality of life and a lower risk of periprosthetic fracture than uncemented hemiarthroplasty. (Funded by the National Institute for Health Research; WHiTE 5 ISRCTN number, ISRCTN18393176.).Copyright © 2022 Massachusetts Medical Society.

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