Can a cementless partial hip prosthesis be preferred in patients with hip fractures when the Spotorno criterion is greater than 5?

Aims: Partial hip arthroplasty is preferred in elderly patients with low activity levels, numerous comorbidities, and limited mobility for hip fractures. To decide whether to use cement in femoral stem implantation, scoring systems such as Spotorno, Dorr, and Canale Flare Indices are used. Generally, cemented application is frequently for patients with over 5 points according to Spotorno criteria. In this study, our aim is to present the outcomes of patients who had a score of 5 or more according to the Spotorno criteria and required cemented prostheses but instead received cementless partial hip prostheses. Methods: Patients who underwent partial hip arthroplasty due to post-traumatic femoral neck fractures in our hospital’s orthopedics and traumatology clinic between 2017 and 2021 were retrospectively evaluated. To calculate the total score according to the Spotorno criteria, which evaluate age, sex, singh index and morphological cortical index, the radiographs of the patients included in the study were assessed, and the Singh index and morphological cortical index (MCI) were calculated.Periprosthetic fractures, prosthesis dislocations, heterotopic ossification, femoral loosening and mortality had been recorded. A total of 192 patients over the age of 70 with ASA III and ASA IV who underwent cementless partial hip arthroplasty were included in the study. Among these patients, 126 were female (% 5.7) and 66 were male (%34.3). Mean follow up was 5.8 years (0-7 years). Results: According to the Spotorno criteria, the total score for all patients was greater than 6. Periprosthetic fractures were detected in % 3.1. Heterotopic ossification was observed in %9.3. In the postoperative 1st month, mortality was observed in %5. Conclusion: Cementless hip arthroplasty in elderly patients with a Spotorno score of 5 or higher can be as effective and applicable as cemented hip arthroplasty. Although the literature generally recommends cemented hip prostheses for such patients, cementless partial hip arthroplasty can be a viable option if standard latest-generation cementing systems are not available.