Cemented or uncemented hemiarthroplasty for the treatment of femoral neck fractures?

Figures & data

Table 1. Procedural codes (NOMESCO classification) used in this study

Code	Procedure
NF	Hip and thigh
NFB00–99	Primary prosthetic replacement of hip joint
NFB10	Primary hemiarthroplasty of hip joint not using cement
NFB20	Primary hemiarthroplasty of hip joint using cement
NFC00–99	Secondary prosthetic replacement of hip joint
NFH00–99	Miscellaneous operations on hip joint
NFJ00–99	Fracture surgery on hip joint
NFS00–99	Operations for infected tendons, joints, and bones of hip and thigh
NFU00–99	Removal of implants and external fixation devices from hip and femur
NFW00–99	Reoperations on hip or thigh

Figure 1. Annual numbers of cemented and uncemented hemiarthroplasties in Finland during the study period.

Table 2. Background information on the patients, including duration of treatment, mortality, and cost of treatment. These results have not been adjusted via propensity score weighting

	UncementedHA	CementedHA	p-value fordifference(unadjusted)
No. of patients	4,492	20,682
Background characteristics
Mean age	81	81	0.002
Men, %	26.2	26.2	0.5
Admitted from long-term care, %	12.9	11.9	0.04
Patients using calcium and vitamin D, %	20.5	18.3	< 0.001
Patients using antiosteoporotic agents, %	17.3	17.8	0.2
Heart disease, %	46.5	39.2	< 0.001
Alcoholism, %	2.7	2.7	0.4
Cancer, %	12.7	13.5	0.08
Chronic obstructive pulmonary disease, %	14.3	13.2	0.02
Dementia, %	23.8	20.4	< 0.001
Depression, %	25.6	24.9	0.2
Parkinson’s disease, %	6.2	6.2	0.4
Mental disorders, %	14.1	13.4	0.1
Rheumatoid arthritis, %	6.7	6.2	0.1
Cerebrovascular disease, %	19.3	16.7	< 0.001
Treatment, outcomes and costs
30-day mortality, %	8.7	8.6	0.4
Home at day 120, %	53.5	56.9	< 0.001
120-day mortality, %	18.0	17.1	0.07
Home at day 365, %	49.0	53.0	< 0.001
365-day mortality, %	27.4	25.4	0.003
The average duration of first treatment
episode in hospital, days	6.6	7.4	< 0.001
Mean costs until discharge home, in €	10,990	12,050	< 0.001

Figure 2. The relative and cumulative risk of death in patients receiving a cemented hemiarthroplasty compared to patients receiving an uncemented hemiarthroplasty. Mortality was higher in the cemented group until day 4. From day 5 onward, no statistically significant difference in mortality was found.

Table 3. The occurrence of certain diagnostic codes and new operations on the hip joint in patients within 90 days of the index procedure

	UncementedHA(%)	CementedHA(%)	HR (95% CI)	p-value fordifference(unadjusted)
Ischemic heart disease (acute)	2.41	2.16	0.90 (0.73–1.11)	0.3
Ischemic heart disease (chronic)	8.40	7.86	0.93 (0.83–1.04)	0.2
Pulmonary embolism	0.94	0.86	0.92 (0.66–1.28)	0.6
Heart insufficiency	4.21	4.71	1.12 (0.96–1.30)	0.1
Cerebrovascular disturbances	2.58	2.79	1.08 (0.89–1.32)	0.4
New femoral fractures	2.85	1.63	0.57 (0.46–0.70)	< 0.001
Infectious complications	2.30	1.89	0.82 (0.66–1.02)	0.08
Mechanical complications	3.72	2.77	0.74 (0.62–0.88)	< 0.001
Re-arthroplasties of hip (NFC00–99)	1.66	0.95	0.57 (0.43–0.74)	< 0.001
Fracture surgeries on femur (NFJ00–99)	1.19	0.52	0.44 (0.32–0.61)	< 0.001
Operations for infection (NFS00–99)	0.42	0.27	0.65 (0.38–1.10)	0.1
Implant removals (NF00–99)	1.29	0.78	0.60 (0.44–0.82)	0.001
Reoperations on hip or thigh (NFW00–99)	0.76	0.50	0.66 (0.44–0.97)	0.03