Lower reoperation rate for cemented hemiarthroplasty than for uncemented hemiarthroplasty and internal fixation following femoral neck fracture

Figures & data

Figure 1. Flow chart describing the cohorts, with inclusions and exclusions. HA: hemiarthroplasty; uncemented coated: uncemented hydroxyapatite-coated.

Table 1. Reoperations by implant. For patients at risk, attrition was mostly due to high mortality. Values are number of reoperations/patients at risk

	Year	Year	Years	Years	Years
	1	2	3–5	6–10	11–19
Internal fixation	25/180	4/105	3/82	1/41	0/13
Uncemented HA	14/203	4/125	3/99	1/54	0/15
Cemented HA	7/209	0/147	2/120	2/65	0/19
Uncemented coated HA ^a	12/157	2/94	7/74	2/39	2/9
Total	58/749	10/471	15/375	6/199	2/56

HA: hemiarthroplasty. ^a Hydroxyapatite coated.

Table 2. Key patient demographics for 749 patients in the 4 cohorts

	Cohort 1	Cohort 2	Cohort 3	Cohort 4
	Internal	Uncemented	Cemented	Uncemented
	fixation	HA	HA	coated HA	p-value
No. of patients	180	203	209	157	–
Median age (IQR)	83 (79–87)	84 (80–87)	83 (79–88)	85 (80–89)	0.2
Sex, females/males	129/51	163/40	169/40	127/30	0.09
Median CCI score (IQR)	2 (0–3)	1 (0–3)	1 (0–3)	1 (0–3)	0.4
Median patient survival, years (IQR)	2.8 (0.1–9.9)	2.5 (0.1–9.7)	2.9 (0.1–10.7)	2.2 (0.0–9.0)	0.5
Failure (%)	33 (18.3)	22 (10.8 )	11 (5.3)	25 (15.9)	See Table 5

HA: hemiarthroplasty; IQR: interquartile range; CCI: Charlson comorbidity index.

Figure 2. Kaplan-Meier implant survival curves, by type of operation.

Table 3. Reasons for reoperation

	Internal	Uncemented	Cemented	Uncemented
	fixation	HA	HA	coated HA
Osteosynthesis failure	28	0	0	0
Arthrosis	4	2	0	0
Dislocation	0	3	5	8
Loosening	0	2	0	0
Periprosthetic fracture	0	13	6	14
Infection	1	2	0	2
Unknown	0	0	0	1
Total	33	22	11	25

HA: hemiarthroplasty.

Table 4. Type of reoperation

	Internal	Uncemented	Cemented	Uncemented
	fixation	HA	HA	coated HA
Total hip arthroplasty	24	8	5	13
Cemented HA	6	3	0	3
Girdlestone	2	1	0	1
Osteosynthesis	0	10	6	8
Re-osteosynthesis	1	0	0	0
Total	33	22	11	25

HA: hemiarthroplasty.

Table 5. Survival analysis of hip failure adjusted for sex, comorbidity, and age (all non-significant)

	HR	95% CI	p-value	HR	95% CI	p-value
Internal fixation	1 (ref)			3.8	1.9–7.5	< 0.001
Uncemented HA	0.6	0.3–1.0	0.05	2.2	1.1–4.5	0.04
Cemented HA	0.3	0.1–0.5	< 0.001	1 (ref)
Uncemented coated HA	1.0	0.6–1.6	0.9	3.6	1.8–7.4	< 0.001

HR: hazard ratio; CI: confidence interval; HA: hemiarthroplasty.