Purpose: The appropriate means of fixation for hemiarthroplasty of the hip is a matter of ongoing debate. Proponents of uncemented components cite the risk of perioperative mortality with cement implantation as justification for avoiding cement in certain patients. Because cement-related mortality is rare, we wished to compare the incidence of perioperative mortality in patients receiving cemented versus uncemented hemiarthroplasty using a large national database. Further, we wished to compare overall revision rate between fixation methods to assess their role in implant survivorship.

Method: All recorded hemiarthroplasty cases from the AOA National Joint Replacement Registry were cross-referenced to the Australian mortality data, and deaths at 1d, 7d, 28d, and one year were compared between groups. Further, subgroup analysis of monoblock, modular, and bipolar hemiarthroplasty were compared as a surrogate measure of different patient populations.

Results: Comparing all hemiarthroplasty procedures as a group, there was a a significantly increased mortality rate at day one post-operatively (p = 0.0005) when cement was used. By day 7, this trend reversed, revealing a reduced mortality risk with cement (p = 0.02). This trend reversal persisted at day 28 and one year post-operatively (p = 0.028 & p < 0.0001, respectively). With subgroup analysis, monoblock hemiarthroplasty revealed a similar trend reversal in early versus late mortality. Modular and bipolar hemiarthroplasty procedures failed to reveal a significant difference in mortality when cemented and uncemented components were compared at all time points. When fixation method was compared in different age groups, a favourable mortality rate was seen at one year when cemented monoblock components were used in patients aged 71–80, and in patients ≥81 years old (p = 0.005 & < 0.001, respectively). The opposite was true with cemented modular implants at one year in patients < 70 years old (p = 0.009). There was no significant difference in mortality between cemented and uncemented implants in any other age investigated. Revision rates were significantly higher in patients treated with uncemented hemiarthroplasty regardless of prosthesis type.

Conclusion: This study demonstrates a higher overall success rate, and comparable or reduced long-term mortality risk when cement is used in hip hemiarthroplasty.

The referral time for spine surgery consultation in Halifax is approximately one year. We currently do not understand the significance of delay in surgical consultation, nor do we have documentation of patient-perceived effects of this delay. Identifying patient characteristics associated with spine pathology mandating earlier surgical intervention would have obvious benefit in streamlining this population in our referral pattern. Furthermore, outlining patient characteristics who are unlikely to benefit from orthopaedic surgical assessment for spine surgery may facilitate community management of spinal pathology and accordingly improve wait times for surgical consultation.

The aim of this study was to Identify patient variables that are predictive of need for early surgical evaluation. Also, to assess patient and surgeon satisfaction with wait times for consultation.

Demographic data and questionnaires were prospectively collected on all consenting patients seen by two orthopaedic spine surgeons over a two week period. Patient and surgeon impression of wait was documented, in addition to Oswestry Disability Index (ODI) scores, and the Visual Analogue Scale (VAS) to document pain. Surgeon reasons for scheduling or delaying surgical planning were also documented and correlated to patient scores.

The average wait time for surgical consultation was 9.7 months, with a mode of sixteen months. 62.8% of patients felt that earlier consultation would be more appropriate, while 31.1% felt that they had deteriorated due to the delay. In addition, 26% felt that the delay negatively influenced their prognosis. Treating surgeons felt that the patient should have been seen sooner in 39% of cases, and that delay in consultation negatively affected prognosis in 6.2% of cases. Of two hundred and forty-two patients completing the survey over the two week period, only ten (4.1%) were scheduled for surgery.

Both patients and physicians felt that prolonged referral-consultation wait times were unacceptable, and deleteriously affected prognosis in a significant proportion of cases. The majority of patients seen were not deemed surgical candidates, indicating room for improvement in referral patterns.