The Influence of Femoral Fixation on Mortality and Revision After Hip Arthroplasty in Femoral Neck Fractures in Patients Older Than 65 Years. A Matched Cohort Analysis From the American Joint Replacement Registry

Abstract

Introduction: In the United States, most hip arthroplasties for femoral neck fractures are done with a noncemented stem despite worldwide registry data suggesting that cemented fixation has improved longterm survivorship in patients older than 65 years. We, therefore, evaluated the effect of femoral fixation on the risk of revision, revision for periprosthetic fracture (PPFx), and mortality in patients undergoing hip arthroplasty for femoral neck fractures.Methods: Seventeen thousand one hundred thirty-eight cases of cemented femoral stems were exactly matched to noncemented fixation cases in a 1:1 fashion based on age, sex, and Charlson Comorbidity Index as reported in the American Joint Replacement Registry. Outcome variables included revision for PPFx, all-cause revision within 1 year and 90 days, and in-hospital mortality at 90 days and 1 year. The primary independent variable was femoral fixation (cemented and noncemented), and covariates included race (black, white, and others), ethnicity (Hispanic and non-Hispanic), hospital teaching status (minor, major, and nonteaching), and hospital size (number of beds: 1 to 99, 100 to 399, and $400). Chi square tests and multivariable logistic regression models were used for statistical analysis.Results: Hip arthroplasty with a cemented stem was associated with a 30% reduction in all-cause revision at 90 days (odds ratio [OR]:0.692, confidence interval [CI]:0.558 to 0.86), a 29% reduction in revision at 1 year (OR:0.709, CI:0.589 to 0.854), and an 86% reduction in revision for PPFx (OR:0.144, CI:0.07 to 0.294). However, cemented stem fixation was associated with increased odds of in-hospital (OR: 2.232 CI: 1.644 to 3.3031), 90-day, and 1-year (OR:1.23, CI:1.135 to 1.339; and OR:1.168, CI:1.091 to 1.25, respectively) mortality.

Difference in early all-cause mortality among patients having hip arthroplasty a Swedish perioperative registry study 2013–2022

“…The one-year mortality was 23.9% in the cemented group and 27.8% in the uncemented group. Springer et al [ 16 ] and Kheir et al [ 29 ] found likewise in register-based studies from US a clear reduction in the risk of revision in patients having undergone cemented arthroplasty for hip fracture patients. Springer et al also found that stem cemented fixation was associated with an increased odds ratio of in-hospital, 90-day and one-year mortality.…”

Hip & Pelvis

“…We were delighted to see this paper from the American Joint Replacement Registry examining this practice in the USA . 8 The authors evaluated the effect of femoral fixation on the risk of revision, revision for periprosthetic fracture (PPFx), and mortality in patients undergoing hip arthroplasty for femoral neck fractures. There were relatively few cases available as the registry is not terribly large and not mandated, so the results of this study are based on 17,138 cemented cases recorded in the registry which were matched on a 1:1 basis with uncemented stems with matching by age, sex, and Charlson Comorbidity Index.…”