Surgical Approach Tied to Hip Revision Risk Level

Cemented fixation is associated with a statistically significantly lower risk of revision hip arthroplasty than uncemented fixation, according to a new study.

Researchers at Kaiser Permanente Research Group (KP; San Diego, USA), and other organizations conducted a retrospective cohort study involving 12,491 patients (median age 83 years; 69.3% women), who underwent hemiarthroplasty treatment for hip fracture at one of 36 KP hospitals. The researchers compared outcomes of hemiarthroplasty fixation via bony growth into an uncemented porous-coated implant, or with cement. The primary outcome was aseptic revision, with secondary outcomes including mortality and 90-day medical complications, emergency department visits, and unplanned readmissions.

The results showed that 48.4% of the hemiarthroplasty patients underwent uncemented fixation and 51.6% underwent cemented fixation. Uncemented fixation was associated with a significantly higher risk of aseptic revision (3%) than cemented fixation (1.3%). Of the six pre-specified secondary end points, none showed a statistically significant difference between groups, including in-hospital mortality and overall mortality. The study was published on March 17, 2020, in the Journal of the American Medical Association (JAMA).

“Among patients with hip fracture treated with hemiarthroplasty in a large US integrated health care system, uncemented fixation, compared with cemented fixation, was associated with a statistically significantly higher risk of aseptic revision,” concluded Kanu Okike, MD, MPH, of Kaiser Permanente Hawaii, and colleagues. “These findings suggest that surgeons should consider cemented fixation in the hemiarthroplasty treatment of displaced femoral neck fractures, in the absence of contraindications.”

Hip arthroplasty is the standard approach for treatment of displaced femoral neck fractures in older patients, and is preferred over fracture fixation, due to the tenuous blood supply of the proximal femur. During the procedure, fixation of the femoral stem can be accomplished with cement or via bony growth into a porous-coated implant (uncemented), with choice of fixation based on surgeon preference. In elective total hip arthroplasty uncemented femoral components are currently favored by US orthopedic surgeons, whereas cemented stems are preferred by European orthopedists.

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Kaiser Permanente Research Group