Efectividad y seguridad de prótesis de cadera cementadas versus no cementadas en adultos mayores con fractura de cadera: revisión sistemática

Abstract

Objective: To compare the effectiveness and safety of cemented and uncemented hip prostheses in adults aged 60 years or older with hip fracture. Methods: A systematic review (with searches conducted in 2026, including publications from 2020 onward) of 16 studies, with narrative synthesis and no meta-analysis, was conducted. Clinical trials were assessed using the RoB 2 tool, cohort studies using ROBINS-I, and the certainty of the evidence across eleven outcomes using the GRADE system. Limitations in screening traceability process and the absence of accredited independent assessment were identified. Results: A total of thirteen studies evaluated hemiarthroplasty and three evaluated total hip arthroplasties. In WHiTE 5, quality of life at four months favored cementation, with an adjusted mean difference in the EQ-5D score of 0.055 (95% CI: 0.009–0.101). Periprosthetic fractures occurred in 3 of 610 patients versus 13 of 615 patients. Twelve-month mortality showed no conclusive difference: the odds ratio (OR) for cemented versus uncemented prostheses was 0.80 (95% CI: 0.62–1.05). No consistent superiority was found in functional outcomes. Some cohort studies associated cementation with fewer revisions, while others reported greater cardiopulmonary compromise in particularly frail patients. The certainty of the evidence was moderate for quality of life, periprosthetic fracture, and mortality; low for function and subsequent interventions; and very low for extrapolating findings on serious cardiopulmonary events to the broader population of older adults with hip fracture. Conclusion: Cementation probably reduces periprosthetic fractures after hemiarthroplasty and may reduce certain subsequent interventions, without demonstrating consistent superiority in function or mortality. Interpretation requires consideration of the procedure, follow-up, and limitations of the evidence and the review. Keywords: hip fracture, cemented arthroplasty, uncemented arthroplasty, older adult, systematic review