Key result
Cemented hemiarthroplasty showed no significant difference in 30-day in-hospital mortality versus cementless (HR 1.2; 95% CI 0.89-1.6; p=0.23), but was associated with higher 1- to 10-day mortality.
Why the study?
Cemented hemiarthroplasty has long-term benefits in vulnerable hip fracture populations, but its association with short-term mortality remains controversial.
Does cemented hemiarthroplasty increase short-term in-hospital mortality compared to cementless hemiarthroplasty in elderly patients with femoral neck fracture?
Cohort (n=31,322)
Yes
Does cemented hemiarthroplasty increase short-term in-hospital mortality compared to cementless hemiarthroplasty in elderly patients with femoral neck fracture?
Hazard Ratio: 1.2 (95% CI 0.89–1.6)
p-value: p=0.23
Cemented hemiarthroplasty is associated with an increased risk of very short-term (1-10 day) mortality, stroke, and ICU admission compared to cementless hemiarthroplasty, though 30-day mortality is similar.
Cemented hemiarthroplasty may raise early mortality risk; should not yet change practice and leaves open optimal fixation in elderly hip fracture.
OBJECTIVE: Cemented hemiarthroplasty is recommended for the vulnerable hip fracture population because of beneficial long-term outcomes. However, the association between cemented hemiarthroplasty and short-term mortality is controversial. To increase a preparedness of potential complication after cemented hemiarthroplasty, we aimed to evaluate the trajectory of the effect of cemented hemiarthroplasty on short-term in-hospital outcomes. METHODS: We investigated in-hospital mortality and complications between cemented hemiarthroplasty and cementless hemiarthroplasty using a nationwide multicenter database from 2010 to 2016 with a propensity-score matching analysis. We analyzed in-hospital mortality from 1 to 14 days after surgery. We also investigated in-hospital complications that may associate with mortality. RESULTS: After matching of 31,322 cases, we found no significant difference in 30-day in-hospital mortality between the cemented and cementless hemiarthroplasty groups (hazard ratio, HR [95% confidence interval, CI], 1.2 [0.89-1.6], p = 0.23). However, the 1- to 10-day postoperative mortality rates were significantly higher in the cemented group and the association becomes weaker as the postoperative period increased (day 1; HR [95% CI]: 3.5 [1.6-7.68]; day 10; HR [95% CI]: 1.59 [1.07-2.37]). The incidence of stroke and intensive care unit (ICU) admission was also significantly higher in the cemented group. CONCLUSION: Cemented hemiarthroplasty was not significantly associated with an increase in overall in-hospital mortality but was significantly associated with short-term mortality from 1-day to 10-day after surgery. The incidence of stroke and ICU admission was also significantly higher in the cemented group. Surgeons should pay more attention to the risk of mortality and stroke in patients undergoing cemented hemiarthroplasty, especially in the early days of hospitalization.
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Ogawa et al. (2021) conducted a cohort in Femoral Neck Fracture (n=31,322). Cemented hemiarthroplasty vs. Cementless hemiarthroplasty was evaluated on 30-day in-hospital mortality (HR 1.2, 95% CI 0.89-1.6, p=0.23). Cemented hemiarthroplasty showed no significant difference in 30-day in-hospital mortality versus cementless (HR 1.2; 95% CI 0.89-1.6; p=0.23), but was associated with higher 1- to 10-day mortality.
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