Association Between the Femoral Stem Design Type and the Risk of Aseptic Revision After Hemiarthroplasty.
Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip
/ adverse effects
Bone Cements
/ adverse effects
Female
Femoral Neck Fractures
/ surgery
Hemiarthroplasty
/ adverse effects
Hip Prosthesis
/ adverse effects
Humans
Male
Middle Aged
Prosthesis Design
Reoperation
Retrospective Studies
Treatment Outcome
Journal
The Journal of the American Academy of Orthopaedic Surgeons
ISSN: 1940-5480
Titre abrégé: J Am Acad Orthop Surg
Pays: United States
ID NLM: 9417468
Informations de publication
Date de publication:
01 Mar 2022
01 Mar 2022
Historique:
received:
04
03
2021
accepted:
21
12
2021
pubmed:
22
1
2022
medline:
1
3
2022
entrez:
21
1
2022
Statut:
ppublish
Résumé
Although noncemented hemiarthroplasty has been associated with a higher risk of revision surgery as compared with cemented fixation, it remains uncertain whether this increased risk applies to all noncemented stem design types or only a subset. The purpose of this study was to assess the risk of aseptic revision associated with three common types of noncemented stem designs as compared with cemented fixation in the hemiarthroplasty treatment of femoral neck fractures in the elderly patients. This was a retrospective cohort study of patients aged 60 years and older who sustained a hip fracture and underwent hemiarthroplasty between 2009 and 2018 at one of 35 hospitals owned by a large US health maintenance organization. Hemiarthroplasty fixation was categorized as cemented or noncemented, with the noncemented stems further classified as single wedge without collar, fit and fill without collar, or fit and fill with collar. The primary outcome was aseptic revision, and the median follow-up time was 4.8 years. Of 12,071 patients who underwent hemiarthroplasty during the study period (average age 82.0 ± 8.4 years, 67.9% women), 807 (6.7%) received a single-wedge stem without collar, 2,124 (17.6%) received a fit-and-fill stem without collar, 2,453 (20.3%) received a fit-and-fill stem with collar, and 6,687 (55.4%) received a cemented stem. Compared with cemented fixation, all the noncemented stem design types were associated with a markedly higher risk of aseptic revision in the multivariable analysis, including single wedge without collar (hazard ratio [HR] 2.00, 95% confidence interval [CI], 1.38 to 2.89, P < 0.001), fit and fill without collar (HR 1.52, 95% CI, 1.14 to 2.04, P = 0.005), and fit and fill with collar (HR 2.11, 95% CI, 1.63 to 2.72, P < 0.001). In the hemiarthroplasty treatment of elderly patients with hip fracture, all routinely used noncemented stem design types were associated with a higher risk of aseptic revision as compared with cemented fixation.
Identifiants
pubmed: 35061631
doi: 10.5435/JAAOS-D-20-01312
pii: 00124635-202203010-00011
doi:
Substances chimiques
Bone Cements
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
229-237Informations de copyright
Copyright © 2022 by the American Academy of Orthopaedic Surgeons.
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