Are We Training Surgeons to Cement a Femoral Component in Hip Arthroplasty? The Trainees’ Perspective

Ryan, J. Conner; Duensing, Ian; Novicoff, Wendy M.; Browne, James A.

doi:10.1016/j.arth.2022.03.005

Cited by 9 publications

(6 citation statements)

References 29 publications

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“…Therefore, the cementing technique and management of implant malposition, which are addressed in concerns about using cemented stems, may be the reasons why cemented stems are not widely used. In fact, orthopedic surgeon trainees in the United States feel prepared to cement a femoral component, but they perceive that they do not receive su cient training in the cement technique (23). In this region, supervisory doctors also have less experience with cemented stems and concerns about the management of implant malposition.…”

Section: Discussionmentioning

confidence: 99%

Current femoral stem fixation in hip arthroplasty for hip fractures after the revised national guidelines in Japan: a questionnaire survey in a super-aging prefectural area

Miura

Kijima

Tazawa

et al. 2022

Preprint

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BackgroundThe Japanese guidelines for the management of hip fractures were most recently revised in 2021 to recommend the use of cemented stems in cases of bone fragility. However, the selection of cementless or cemented stem fixations remains controversial. This study aimed to examine the current stem selection strategy in bipolar hemiarthroplasty, concerns about using cemented stems, and factors affecting the ability to instruct cemented stems.MethodsThis study included 94 orthopedic surgeons from 27 facilities who answered a web-based questionnaire survey of 15 questions in the super-aging prefectural area in Japan from January to February 2022. Multiple logistic regression analysis was used to identify the factors associated with the ability to instruct the cemented stem. The cutoff value for the number of cemented stem usage experiences that can be used to instruct cemented stems was determined using the receiver operating characteristic (ROC) curve.ResultsA total of 97.8% of doctors answered that the cementless stem was the current first choice, and 83.0% of doctors had only 0–10 cases of the cemented stem. Meanwhile, only 14.9% of doctors are expected to increase the use of cemented stems in the future. The cement technique was the greatest concern regarding the use of cement stems (60.6%). On multivariate analysis, the number of surgeries of the cemented stem was the factor most affecting the ability to instruct the cemented stem (odds ratio: 8.42, p=0.001). In the ROC curve analysis for the capability of instructing cemented stems and the number of surgeries using cemented stems, the best cutoff value was 1–10 cases (sensitivity, 94.4%; specificity, 58.6%), with an area under the curve of 0.8448 (95% confidence interval: 0.7754–0.9142). When the cut-off value was 11–50 cases, the specificity was higher (sensitivity, 41.7%; specificity, 98.3%).ConclusionsA few doctors still select cemented stems as the first choice. The number of surgeries on the cemented stem was the factor most affecting the ability to instruct the cemented stem, and more than 11 cases are desirable.

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Section: Discussionmentioning

confidence: 99%

Current femoral stem fixation in hip arthroplasty for hip fractures after the revised national guidelines in Japan: a questionnaire survey in a super-aging prefectural area

Miura

Kijima

Tazawa

et al. 2022

Preprint

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“…Graduate candidates of North American orthopaedic residency programs were queried on their training in cementing a femoral stem in a recent study 30…”

Section: Resident Educationmentioning

confidence: 99%

“…Graduate candidates of North American orthopaedic residency programs were queried on their training in cementing a femoral stem in a recent study 30 . Ryan et al reported that, in the 152 surveys returned, only 37% of resident respondents perceived their training in cementation technique to be comprehensive or very comprehensive, with 17% reporting that their training was inadequate or nonexistent.…”

Section: Resident Educationmentioning

confidence: 99%

What’s New in Hip Replacement

Morgan

2022

Journal of Bone and Joint Surgery

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Implant Design and Related Outcomes Dual MobilityDual-mobility cups do not reduce the revision risk for patients with acute femoral neck fracture, as concluded by Rogmark and Nauclér in an observational cohort of 2,242 patients with dual-mobility cups compared with a matched cohort of 6,726 patients treated with a conventional total hip implant 1 . The authors reported that, with implant revision surgery as the outcome, they "could not detect any differences between a total hip arthroplasty with a dual mobility cup and one with conventional bearing." Outcomes were similar and independent of whether the implants were inserted via a direct lateral or posterior approach as well as for subgroup analyses of revision for dislocation and infection. The authors concluded that improvements in the care of patients with hip fracture are most likely to come from elsewhere in the care pathway and "not in design variations of contemporary orthopedic implants."Cnudde et al. reported similar findings when they investigated patients with neurologic disease undergoing arthroplasty for femoral neck fracture 2 . Comparing hemiarthroplasty, conventional total hip arthroplasty (THA), and dual-mobility THA performed in 9,638 patients with conditions such as Alzheimer and Parkinson diseases, the authors found that there was an increased risk of dislocation when comparing hemiarthroplasty and THA with a <32-mm head but not with conventional THA with a 32-mm head (hazard ratio [HR], 1.54 [95% confidence interval (CI), 0.94 to 2.51]; p = 0.083) and THA with a dual-mobility implant (HR, 0.68 [95% CI, 0.26 to 1.84]; p = 0.451). Overall, the authors found no difference in the rate of reoperation or revision-free survival between any of the different prostheses or sizes of the femoral head. Cobalt-ChromiumUsing data from the National Joint Registry linked to U.K. National Health Service (NHS) English hospital inpatient episodes for 374,359 primary THAs, Deere et al. investigated 158,677 hips (42.4%) containing an implant with cobaltchromium 3 . With a maximum 14.5-year follow-up (mean [and Disclosure: The Disclosure of Potential Conflicts of Interest form is provided with the online version of the article (http://links.lww.com/JBJS/H172).

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“…I'm guessing this is in response to trainees wanting more, not less, training in this vital skillset. Indeed, a recent survey of orthopaedic trainees suggested that many young surgeons do not feel they are receiving appropriate training in femoral cementation [10].…”

mentioning

confidence: 99%

CORR Insights: What Are the Mortality, Infection, and Nonunion Rates After Periprosthetic Femoral Fractures in the United States?

LeBrun

2023

Clin Orthop Relat Res

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Are We Training Surgeons to Cement a Femoral Component in Hip Arthroplasty? The Trainees’ Perspective

Cited by 9 publications

References 29 publications

Current femoral stem fixation in hip arthroplasty for hip fractures after the revised national guidelines in Japan: a questionnaire survey in a super-aging prefectural area

Current femoral stem fixation in hip arthroplasty for hip fractures after the revised national guidelines in Japan: a questionnaire survey in a super-aging prefectural area

What’s New in Hip Replacement

CORR Insights: What Are the Mortality, Infection, and Nonunion Rates After Periprosthetic Femoral Fractures in the United States?

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