title: Peri-operative mortality after hemiarthroplasty for fracture of the hip: does cement make a difference?
abstract: We aimed to determine whether cemented hemiarthroplasty is associated with a higher post-operative mortality and rate of re-operation when compared with uncemented hemiarthroplasty. Data on 19 669 patients, who were treated with a hemiarthroplasty following a fracture of the hip in a nine-year period from 2002 to 2011, were extracted from NHS Scotland's acute admission database (Scottish Morbidity Record, SMR01). We investigated the rate of mortality at day 0, 1, 7, 30, 120 and one-year post-operatively using 12 case-mix variables to determine the independent effect of the method of fixation. At day 0, those with a cemented hemiarthroplasty had a higher rate of mortality (p < 0.001) compared with those with an uncemented hemiarthroplasty, equivalent to one extra death per 424 procedures. By day one this had become one extra death per 338 procedures. Increasing age and the five-year co-morbidity score were noted as independent risk factors. By day seven, the cumulative rate of mortality was less for cemented hemiarthroplasty though this did not reach significance until day 120. The rate of re-operation was significantly higher for uncemented hemiarthroplasty. Despite adjusting for 12 confounding variables, these only accounted for 15% of the observed variability. The debate about the choice of the method of fixation for a hemiarthroplasty with respect to the rate of mortality or the risk of re-operation may be largely superfluous. Our results suggest that uncemented hemiarthroplasties may have a role to play in elderly patients with significant co-morbid disease.
authors.affiliation: Royal Cornwall Hospital, Truro, Cornwall TR1 3LJ, UK.
authors.forename: R G
authors.initials: RG
authors.lastname: Middleton
authors.affiliation: Leicester Royal Infirmary, Leicester, Leicestershire, LE1 5WW, UK.
authors.forename: C E
authors.initials: CE
authors.lastname: Uzoigwe
authors.affiliation: Southern General Hospital, Glasgow, Lanarkshire G51 4TF, UK.
authors.forename: P S
authors.initials: PS
authors.lastname: Young
authors.affiliation: Scottish Hip Fracture Audit, Edinburgh EH12 9EB, UK.
authors.forename: R
authors.initials: R
authors.lastname: Smith
authors.affiliation: Cheltenham General Hospital, Cheltenham, Gloucsestershire GL53 7AN, UK.
authors.forename: H S
authors.initials: HS
authors.lastname: Gosal
authors.affiliation: Crosshouse Hospital, Kilmarnock, East Ayrshire, KA2 0BE, UK.
authors.forename: G
authors.initials: G
authors.lastname: Holt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation / Q000379:methods / Q000401:mortality*; D001843:Bone Cements; D005260:Female; D062785:Hemiarthroplasty / Q000295:instrumentation / Q000379:methods / Q000401:mortality*; D006620:Hip Fractures / Q000401:mortality / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements
keywords: Cement; Hemiarthroplasty; Hip; Hip fracture; Mortality