Cemented or Uncemented Hemiarthroplasty for Femoral Neck Fracture? Data from the Norwegian Hip Fracture Register

Abstract

Background A displaced femoral neck fracture in patients older than 70 years is a serious injury that influences the patient’s quality of life and can cause serious complications or death. Previous national guidelines and a Cochrane review have recommended cemented fixation for arthroplasty to treat hip fractures in older patients, but data suggest that these guidelines are inconsistently followed in many parts of the world; the effects of that must be better characterized. Questions/purposes The purpose of this study was to evaluate a large group of patients in the Norwegian Hip Fracture Register to investigate whether the fixation method in hemiarthroplasty is associated with (1) the risk of reoperation; (2) the mortality rate; and (3) patient-reported outcome measures (PROMs). Methods Longitudinally maintained registry data from the Norwegian Hip Fracture Register with high completeness (93%) and near 100% followup of deaths were used for this report. From 2005 to 2017, 104,993 hip fractures were registered in the Norwegian Hip Fracture Register. Fractures other than intracapsular femoral neck fractures and operative methods other than bipolar hemiarthroplasty, such as osteosynthesis or THA, were excluded. The selection bias risk on using cemented or uncemented hemiarthroplasty is small in Norway because the decision is usually regulated by tender processes at each hospital and not by surgeon. A total of 7539 uncemented hemiarthroplasties (70% women, mean age, 84 years [SD 6] years) and 22,639 cemented hemiarthroplasties (72% women, mean age, 84 years [SD 6] years) were eligible for analysis. Hazard risk ratio (HRR) on reoperation and mortality was calculated in a Cox regression model adjusted for age, sex, comorbidities (according to the American Society of Anesthesiologists classification), cognitive function, surgical approach, and duration of surgery. At 12 months postoperatively, 65% of patients answered questionnaires regarding pain and quality of life, the results of which were compared between the fixation groups. Results A higher overall risk of reoperation for any reason was found after uncemented hemiarthroplasty (HRR, 1.5; 95% CI, 1.4–1.7; p < 0.001) than after cemented hemiarthroplasty. When assessing reoperations for specific causes, higher risks of reoperation because of periprosthetic fracture (HRR, 5.1; 95% CI, 3.5–7.5; p < 0.001) and infection (HRR, 1.2; 95% CI, 1.0–1.5; p = 0.037) were found for uncemented hemiarthroplasty than for cemented procedures. No differences were found in the overall mortality rate after 1 year (HRR, 1.0; 95% CI, 0.9–1.0; p = 0.12). Hemiarthroplasty fixation type was not associated with differences in patients’ pain (19 versus 20 for uncemented and cemented hemiarthroplasties respectively, p = 0.052) or quality of life (EuroQol [EQ]-VAS score 64 versus 64, p = 0.43, EQ5D index score 0.64 versus 0.63, p = 0.061) 1 year after surgery. ...

Cognitive impairment influences the risk of reoperation after hip fracture surgery: results of 87,573 operations reported to the Norwegian Hip Fracture Register

“…It is well established that uncemented hemiarthroplasties have a higher risk of revision than cemented (Langslet et al 2014, Kristensen et al 2020.…”

Comparison Between Cemented and Uncemented Hemiarthroplasty in Patients With Femoral Neck Fractures: A Systematic Review and Meta-analysis

“…The latest RCT reported 3 deaths that may have been caused by BCIS [15], and Moerman also reported one death possible caused by it [26]. Similar events have been reported by other trials, as well as Australian joint replacement registry [23,21,44]. Movrin [16] noted that there were 8 (10.1%) events of an intraoperative drop in the oxygen saturation (SaO2) in the CHA group, which may have been the reason for BCIS.…”

Fracture-related outcome study for operatively treated tibia shaft fractures (F.R.O.S.T.): registry rationale and design

“…Wennergren et al recently published results from the Swedish Fracture Register [ 33 , 34 ], mainly describing epidemiology. To date, however, most registries still primarily focus on arthroplasty [ 35 , 36 ]. Therefore, the AO Foundation developed F.RO.S.T.…”