Cementless Hemiarthroplasty Complication Risk Does Not Support Contemporary Utilization Patterns

Abstract

Background: Hemiarthroplasty (HA) is commonly performed in the setting of femoral neck fracture to allow for early mobilization. Fixation of the femoral component can be either press fit or cemented. The purpose of this study was to compare cemented and cementless HA utilization and complications.

Methods: A multicenter retrospective analysis was performed on hip fracture patients from 2010 to 2019. The primary outcome of this study was revision due to periprosthetic fracture. Secondary outcomes included operative time, surgical complications, and mortality. Logistic regression was performed to compare the risk of various complications, adjusting for age, sex, body mass index, and comorbidity status.

Results: During this time period, cementless HA (577, 58.6%) was more commonly performed than cemented HA (407, 41.4%). There was a trend toward increasing cemented fixation over the study period (P < 0.001). Cementless HA patients were younger (77 versus 81, P < 0.001) and had shorter operative times (90.5 ± 35.7 versus 105.0 ± 38.7 minutes, P < 0.001). However, cementless HA patients were less likely to return to independent ambulation (8.2 versus 19.2%, P < 0.001), more likely to undergo revision surgery for periprosthetic fracture (2.6 versus 0.3%, P = 0.0035; odds ratio [OR] 11.06, 95% confidence interval [CI] 1.43 to 85.38), P = 0.021), and had higher dislocation rates (6.1 versus 2.7%, P = 0.014; OR 2.29 (CI 1.13 to 4.67), P = 0.022). Periprosthetic joint infection rates were comparable between groups (4.0 versus 4.9%, P = 0.48; OR 0.71 (CI 0.38 to 1.36), P = 0.31). The 90-day mortality was lower with cementless HA (10.8 versus 19.2%, P < 0.001), though mortality rates were comparable at the final follow-up (OR 1.23 [CI 0.94 to 1.62], P = 0.13).

Conclusions: The surgical complication risk of cementless HA for femoral neck fracture is higher than cemented HA, with an 11-fold increased risk of periprosthetic fracture compared to cemented HA. Surgeons may consider routine use of cemented fixation for hemiarthroplasties performed for femoral neck fractures to mitigate the risk of fracture and need for further surgical intervention.

Keywords: cementless hemiarthroplasty; complications; femoral neck fracture; hemiarthroplasty; periprosthetic joint infection.