Aseptic revisions and pulmonary embolism after surgical treatment of femoral neck fractures with cemented and cementless hemiarthroplasty in Germany: an analysis from the German Arthroplasty Registry (EPRD)

Abstract

Background Femoral neck fractures (FNF) are among the most common fractures in Germany and are often treated by hemiarthroplasty (HA). The aim of this study was to compare the occurrence of aseptic revisions after cemented and uncemented HA for the treatment of FNF. Secondly, the rate of pulmonary embolism was investigated. Methods Data collection for this study was performed using the German Arthroplasty Registry (EPRD). HAs after FNF were divided into subgroups stratified by stem fixation (cemented vs uncemented) and paired according to age, sex, BMI, and the Elixhauser score using Mahalanobis distance matching. Results Examination of 18,180 matched cases showed a significantly increased rate of aseptic revisions in uncemented HA (p < 0.0001). After 1 month 2.5% of HAs with uncemented stems required an aseptic revision, while 1.5% were reported in cemented HA. After 1 and 3 years’ follow-up 3.9% and 4.5% of uncemented HA and 2.2% and 2.5% of cemented HA needed aseptic revision surgery. In particular, the proportion of periprosthetic fractures was increased in cementless implanted HA (p < 0.0001). During in-patient stays, pulmonary emboli occurred more frequently after cemented HA [0.81% vs 0.53% in cementless HA (OR: 1.53; p = 0.057)]. Conclusion For uncemented hemiarthroplasties a statistically significantly increased rate of aseptic revisions and periprosthetic fractures was evident within a time period of 5 years after implantation. During the in-hospital stay, patients with cemented HA experienced an increased rate of pulmonary embolism, but without statistically significant results. Based on the present results, with knowledge of prevention measurements and correct cementation technique, cemented HA should be preferred when using HA in the treatment of femoral neck fractures. Trail registration: The study design of the German Arthroplasty Registry was approved by the University of Kiel (ID: D 473/11). Level of Evidence: Level III, Prognostic.

5-Factor Modified Frailty Index as a Predictor of Outcomes After Hemiarthroplasty or Total Hip Arthroplasty for Femoral Neck Fracture

“…Other proven risk factors for adverse outcomes include age, obesity, smoking history, and increased Elixhauser Comorbidity Measure (ECM). 16,19,22 Although multiple risk stratification tools exist for identifying high-risk populations, there has yet to be a universally accepted tool for arthroplasty. Notably, the ASA classification, CCI, and ECM score have been widely investigated.…”

“…THA for the treatment of femoral neck fractures has been shown to have increased rates of mortality, as well as septic and aseptic failure, when compared with THA used in the treatment of osteoarthritis. 16 Therefore, it is imperative that we explore the predictive value of the mFI-5 in this particular cohort of patients undergoing THA or hemiarthroplasty because it may better inform providers which patients are high risk and would require special perioperative care.…”

Comparison of mortality rate and septic and aseptic revisions in total hip arthroplasties for osteoarthritis and femoral neck fracture: an analysis of the German Arthroplasty Registry

“…Regardless of the underlying disease, which was the reason for THA implantation, increased age, BMI, and number and severity of comorbidities are in general decisive factors [ 5 , 16 ]. While often bone cement implantation syndrome (BCIS) is under suspicion in relation to increased mortality rates, no significant differences between cemented and cementless hemiarthroplasties were reported in a previous investigation [ 21 ].…”

Re-revision and mortality rate following revision total hip arthroplasty for infection

“…3,4 The frequency and proportion of rTHA due to PJI is increasing and is between 16% and 25% according to previously reported registry data. [5][6][7][8] Moreover, rTHA secondary to infection is associated with a increased mortality compared to its aseptic revision. 9 A meta-analysis reports that reinfection rates following one-and two-stage revisions for infection are between 5.7% and 8%, respectively.…”

“…10 Even when excellent results with infection eradication of up to 100% have been reported, the re-revision rate and mortality in literature differ widely, with others reporting an eradication rate of approximately 70%. [6][7][8][11][12][13][14][15] These wide differences raise the question of whether different definitions or criteria for revision and infection eradication are being applied. Different national registries use varying definitions for revisions as shown by Liebs et al 16 Moreover, single-centre retrospective cohort studies or national registries apply different criteria for the inclusion or exclusion of patients.…”