Thurs., 10/4/12 Hip Fractures, PAPER #28, 3:26 pm OTA-2012
A Comparison of Cemented and Uncemented Bipolar Hemiarthroplasty Complications in the Early Postoperative Period
Ross K. Leighton, MD, FRCSC, FACS1,2; Uwe Dahn, MD1; Kelly Trask, BEng, MSc, CCRP2;
1Dalhousie University, Halifax, Nova Scotia, Canada;
2Capital District Health Authority, Halifax, Nova Scotia, Canada
Background/Purpose: While the adverse effects of cement have been well delineated in the literature, cemented bipolar hemiarthroplasties have remained a mainstay of treatment for intracapsular hip fractures. The purposes of this study were: (1) to delineate any complications that occurred in the peri- or postoperative periods, and to determine whether or not these were associated with the use of cement and/or with patient specific factors; (2) to determine whether cementless implants were associated with higher rates of revision.
Methods: All consecutive bipolar hemiarthroplasties from 2001 to the present were retrospectively reviewed. Patient age and gender were recorded, along with surgery date, surgeon, length of stay on the orthopaedic service, and length of stay in hospital overall. Complications occurring in the perioperative period and in the first 48 hours postoperatively were also noted. Finally, any revisions to date of the initial bipolar implants were recorded.
Results: 700 bipolar hemiarthroplasties were performed, 383 (54.7%) cemented and 317 (45.3%) uncemented. Average age of patients was 80.2 years and there was no difference between groups. Females comprised 75.7% of all surgeries and there was no difference between cemented and uncemented groups. There was no difference in the death rate (7.29%) perioperatively, within hospital, or postdischarge (within 6 months). There were significantly more complications in the cemented group (P = 0.015), while the uncemented group was slower to mobilize postoperatively (P = 0.0001). Postoperative delirium and low oxygen saturation were also more prevalent complications in the cemented group (P <0.002). There was no significant difference in revision rate between the cemented (2.6%) and uncemented (1.9%) groups.
Conclusion: Overall there was no significant difference in death rate and revision rate between the cemented and uncemented groups. We found that adverse effects in patients were significantly associated with patient age and use of cement, while the uncemented group was slower to mobilize postoperatively. We thus conclude that, especially in the frail elderly, the uncemented bipolar hemiarthroplasty represents a valuable alternative to the cemented bipolar hemiarthroplasty.
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• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.