The effects of cement fixation on survival in elderly patients with hip hemiarthroplasty: a nationwide cohort study

• Published in: BMC musculoskeletal disorders Vol. 20; no. 1; p. 628
• Main Authors: Tsai, Ming-Che, Ng, Yee-Yung, Chen, Wei-Ming, Tsai, Shang-Wen, Wu, Shiao-Chi
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 27.12.2019; BioMed Central; BMC
• Subjects: Age; Age Factors; Aged, 80 and over; Analysis; Bone Cements - adverse effects; Bone implants; Care and treatment; Cement; Cohort analysis; Comorbidity; Confidence intervals; Elderly patient; Elderly patients; Female; Femoral Neck Fractures - surgery; Femur; Fractures; Fractures (Injuries); Geriatrics; Health; Health insurance; Hemiarthroplasty - adverse effects; Hemiarthroplasty - instrumentation; Hemiarthroplasty - methods; Hip; Hip fractures; Hip hemiarthroplasty; Hip Prosthesis; Hospitalization; Hospitals; Humans; Insurance; Insurance premiums; Joint surgery; Male; Medical research; Mortality; Musculoskeletal diseases; National health insurance; Older people; Patient outcomes; Patients; Physicians; Postoperative Complications - etiology; Postoperative Complications - mortality; Postoperative survival; Regression analysis; Reoperation - statistics & numerical data; Retrospective Studies; Risk Factors; Sex Factors; Statistical analysis; Surgery; Survival; Syndrome; Taiwan - epidemiology; Treatment Outcome; Taiwan; Elderly patient; Cement; Hip hemiarthroplasty; Postoperative survival
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/s12891-019-3013-2

Hip hemiarthroplasty (HHA) is a common treatment for hip fractures in the elderly population. Because of the fatal effects of bone cement implantation syndrome, the safety of cement utilization to enhance implant firmness in the femur is controversial. The aim of this study was to investigate the postoperative survival of elderly patients receiving HHA with and without cement fixation. Claim data from the National Health Insurance Database and the National Register of Deaths Database were used for analysis in this retrospective cohort study. From 2008 to 2014, 25,862 patients aged 80 years or older treated with hip hemiarthroplasty were included in the analysis. A Cox proportional risk model was used to analyse the effects of cement utilization on postoperative mortality. The cemented group had a significantly higher mortality risk than the non-cemented group within 7, 30, 180 days and 1 year after the operation. The effect of bone cement on postoperative mortality was significantly stronger within 7 days than within 30, 180 days and 1 year. In addition, the male gender, age > 85 years and higher score on the Charlson Comorbidity Index were also risk factors for mortality (p < 0.05). Patients who received HHA in lower-volume hospitals had higher mortality rates within 180 days and 1 year than those in higher-volume hospitals. Compared with patients who were operated on by high-volume surgeons, those who received surgery performed by lower-volume surgeons were more likely to die within 30 days (aHR = 1.22), 180 days (aHR = 1.16) and 1 year (aHR = 1.19), respectively. The postoperative mortality rate of elderly patients undergoing HHA was significantly higher in the cemented group than in the non-cemented group.