The impact of cement fixation on early mortality in arthroplasty for hip fracture

Niamh Ramsay; Jacqueline C T Close; Ian A Harris; Lara A Harvey

doi:10.1302/2633-1462.43.BJO-2023-0006.R1

The impact of cement fixation on early mortality in arthroplasty for hip fracture

Bone Jt Open. 2023 Mar 16;4(3):198-204. doi: 10.1302/2633-1462.43.BJO-2023-0006.R1.

Authors

Niamh Ramsay¹, Jacqueline C T Close¹, Ian A Harris², Lara A Harvey¹

Affiliations

¹ Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, New South Wales, Australia.
² School of Clinical Medicine, University of New South Wales Sydney Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia.

PMID: 37051818
PMCID: PMC10032234
DOI: 10.1302/2633-1462.43.BJO-2023-0006.R1

Abstract

Cementing in arthroplasty for hip fracture is associated with improved postoperative function, but may have an increased risk of early mortality compared to uncemented fixation. Quantifying this mortality risk is important in providing safe patient care. This study investigated the association between cement use in arthroplasty and mortality at 30 days and one year in patients aged 50 years and over with hip fracture. This retrospective cohort study used linked data from the Australian Hip Fracture Registry and the National Death Index. Descriptive analysis and Kaplan-Meier survival curves tested the unadjusted association of mortality between cemented and uncemented procedures. Multilevel logistic regression, adjusted for covariates, tested the association between cement use and 30-day mortality following arthroplasty. Given the known institutional variation in preference for cemented fixation, an instrumental variable analysis was also performed to minimize the effect of unknown confounders. Adjusted Cox modelling analyzed the association between cement use and mortality at 30 days and one year following surgery. The 30-day mortality was 6.9% for cemented and 4.9% for uncemented groups (p = 0.003). Cement use was significantly associated with 30-day mortality in the Kaplan-Meier survival curve (p = 0.003). After adjusting for covariates, no significant association between cement use and 30-day mortality was shown in the adjusted multilevel logistic regression (odd rati0 (OR) 1.1, 95% confidence interval (CI) 0.9 to 1.5; p = 0.366), or in the instrumental variable analysis (OR 1.0, 95% CI 0.9 to 1.0, p=0.524). There was no significant between-group difference in mortality within 30days (hazard ratio (HR) 0.9, 95% CI 0.7to 1.1; p = 0.355) or one year (HR 0.9 95% CI 0.8 to 1.1; p = 0.328) in the Cox modelling. No statistically significant difference in patient mortality with cement use in arthroplasty was demonstrated in this population, once adjusted for covariates. This study concludes that cementing in arthroplasty for hip fracture is a safe means of surgical fixation.