More re-operations after uncemented than cemented hemiarthroplasty used in the treatment of displaced fractures of the femoral neck: AN OBSERVATIONAL STUDY OF 11 116 HEMIARTHROPLASTIES FROM A NATIONAL REGISTER

• Published in: Journal of bone and joint surgery. British volume Vol. 94; no. 8; pp. 1113 - 1119
• Main Authors: GJERTSEN, J.-E, LIE, S. A, VINJE, T, ENGESAETER, L. B, HALLAN, G, MATRE, K, FURNES, O
• Format: Journal Article
• Language: English
• Published: London British Editorial Society of Bone and Joint Surgery 01.08.2012
• Subjects: Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Hip - methods; Biological and medical sciences; Cementation; Diseases of the osteoarticular system; Female; Femoral Neck Fractures - epidemiology; Femoral Neck Fractures - surgery; Hip Prosthesis; Humans; Injuries of the limb. Injuries of the spine; Intraoperative Complications - epidemiology; Kaplan-Meier Estimate; Male; Medical sciences; Norway - epidemiology; Orthopedic surgery; Prospective Studies; Prosthesis Failure; Registries; Reoperation - methods; Reoperation - statistics & numerical data; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Traumas. Diseases due to physical agents; Treatment Outcome; Norway; Femoral neck; Fracture dislocation; Orthopedic surgery; Treatment; Diseases of the osteoarticular system; Cement; Hemiarthroplasty; Bone
• ISSN: 0301-620X; 2044-5377
• DOI: 10.1302/0301-620X.94B8.29155

Using data from the Norwegian Hip Fracture Register, 8639 cemented and 2477 uncemented primary hemiarthroplasties for displaced fractures of the femoral neck in patients aged > 70 years were included in a prospective observational study. A total of 218 re-operations were performed after cemented and 128 after uncemented procedures. Survival of the hemiarthroplasties was calculated using the Kaplan-Meier method and hazard rate ratios (HRR) for revision were calculated using Cox regression analyses. At five years the implant survival was 97% (95% confidence interval (CI) 97 to 97) for cemented and 91% (95% CI 87 to 94) for uncemented hemiarthroplasties. Uncemented hemiarthroplasties had a 2.1 times increased risk of revision compared with cemented prostheses (95% confidence interval 1.7 to 2.6, p < 0.001). The increased risk was mainly caused by revisions for peri-prosthetic fracture (HRR = 17), aseptic loosening (HRR = 17), haematoma formation (HRR = 5.3), superficial infection (HRR = 4.6) and dislocation (HRR = 1.8). More intra-operative complications, including intra-operative death, were reported for the cemented hemiarthroplasties. However, in a time-dependent analysis, the HRR for re-operation in both groups increased as follow-up increased. This study showed that the risk for revision was higher for uncemented than for cemented hemiarthroplasties.