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Introduction: Controversy exists regarding the use of cement for hemiarthroplasty to treat displaced intracapsular hip fractures. The aim of this systematic review and meta-analysis was to compare the clinical outcomes between contemporary cemented and contemporary uncemented hemiarthroplasty for the treatment of displaced femoral neck fractures., Methods: Literature searches of PubMed, Scopus, Web of Science, and Cochrane Central, up to May 2017, were performed. We included randomized controlled trials (RCTs) and observational studies comparing contemporary cemented with contemporary uncemented hemiarthroplasty. Data were pooled as mean difference (MD) or risk ratio (RR) with 95% confidence interval (CI) in a meta-analysis model. Studies with the Thompson and Austin Moore prostheses were excluded., Results: A total of 29 studies (9 RCTs and 20 observational studies), with a total of 42,046 hips, were included. Meta-analysis showed that the cemented group was associated with fewer periprosthetic fractures (RR = 0.44, 95% CI [0.21, 0.91]), longer operative time (MD = 11.25 min, 95% CI [9.85, 12.66]), more intraoperative blood loss (MD = 68.72 ml, 95% CI [50.76, 86.69]), and higher heterotopic ossification (RR = 1.79, 95% CI [1.11, 2.88]) compared with the uncemented group. Meta-analysis showed no significant difference in terms of post-operative hip function, hip pain, reoperation rate, prosthetic dislocations, aseptic loosening, wound infection, and hospital stay., Conclusions: This meta-analysis shows that contemporary cemented prostheses have less intra-operative and post-operative fractures, but longer operative time, more intra-operative blood loss, and heterotopic ossifications. Otherwise, there were no significant differences between both groups.

Purpose: Currently, individual studies lack the power to successively illustrate different failure modes; therefore, we undertook a systematic review to examine lateral unicompartmental knee replacement (lat UKR) failure modes. Furthermore, we compared early with midterm and late failures and fixed-bearing with mobile-bearing implants., Methods: A search using the databases of PubMed, EMBASE, Cochrane, and annual registries was performed to search for failed lat UKRs. Studies were included when they reported more than four failures, described failure modes and were minimum level IV studies. Data was analysed based on overall failure modes, fixed- vs. mobile bearing and early (<5 years) vs. midterm (5-10 years) vs. late failures (>10 years)., Results: Fourteen cohort studies and two registry-based studies were included. A total of 336 overall failures, 87 time-dependent failures, and 175 implant-specific failures were identified. The main overall causes of failure were osteoarthritis (OA) progression (30%) and aseptic loosening (22%). These were followed by less common causes such as instability (7%), unexplained pain (5%), infection (5%), polyethylene wear (5%), and bearing dislocation (5%). Bearing dislocation was the most common early failure (29%) and also the most common failure among mobile-bearing implants (27%). In midterm and late failures, OA progression had the highest rates (59% and 78% respectively) and was also the most common type of failure in fixed-bearing implants (44%)., Conclusions: Progression of OA and aseptic loosening are the major overall failure modes in lat UKR. Bearing dislocation was the main failure mode in early years and in mobile-bearing implants, whereas OA progression caused most failures in late years and in fixed-bearing implants., Level of Evidence: Systematic Review of minimum level IV studies.

Purpose: Fracture healing encompasses a succession of dynamic multifactorial metabolic events, which ultimately re-establishes the integrity of the biomechanical properties of the bone. Up to 10% of the fractures occurring annually will need additional surgical procedures because of impaired healing. The aim of this article is to review the current literature regarding the use of bone marrow aspirate concentrate (BMAC) and its effectiveness in the management of bone defects., Methods: We have included all published clinical literature investigating the development, techniques and applications of BMAC. Language, design and risk of bias did not deter the initial inclusion of any study. Our search was exclusively limited to studies involving human subjects. A PRISMA compliant search was carried out as published in 2009. This included the online databases: PubMed, EMBASE, clinical trial.gov and the Cochrane library from 1960 to the end of May 2015. MeSH terms used included: "Bone" AND "Marrow" AND "Aspirate" AND "Concentrate" AND "Bone Defects" AND "NONUNION". Eligible studies were independently appraised by two authors using the Critical Appraisal Skills Program checklist. For the purpose of narrative review, relevant studies were included irrespective of methodology or level of evidence., Results: Thirty-four of the 103 (48 PubMed and 55 EMBASE) results yielded by the preliminary search were included. Exclusions included three duplicate records, six letters, 17 non-orthopaedics related studies and four records irrelevant to our search topic. The CASP appraisal confirmed a satisfactory standard of 31 studies. They all had clearly defined objectives, were well designed and conducted appropriately to meet them. The published studies reported the use of BMAC in non-union and fracture healing (15 studies), bone defects (nine studies), spine fusion (two studies), distraction osteogensis (two studies) and complications related to the use of BMAC (seven studies)., Conclusions: Stem cells found in BMAC have the potential to self-renew, undertake clonal expansion and differentiate into different musculoskeletal tissues. The commercial processing of BMAC needs to be optimized in order to achieve a consistent end product, which will provide predicable and translatable results. The future potential of cell characterization in order to determine the optimum cell for repair/regeneration of bone also needs to be explored., Level of Evidence: Systematic Review of minimum level IV studies.