We aimed to determine whether cemented hemiarthroplasty
is associated with a higher post-operative mortality and rate of
re-operation when compared with uncemented hemiarthroplasty. Data
on 19 669 patients, who were treated with a hemiarthroplasty following
a fracture of the hip in a nine-year period from 2002 to 2011, were extracted
from NHS Scotland’s acute admission database (Scottish Morbidity
Record, SMR01). We investigated the rate of mortality at day 0,
1, 7, 30, 120 and one-year post-operatively using 12 case-mix variables
to determine the independent effect of the method of fixation. At
day 0, those with a cemented hemiarthroplasty had a higher rate
of mortality (p <
0.001) compared with those with an uncemented
hemiarthroplasty, equivalent to one extra death per 424 procedures.
By day one this had become one extra death per 338 procedures. Increasing
age and the five-year co-morbidity score were noted as independent
risk factors. By day seven, the cumulative rate of mortality was
less for cemented hemiarthroplasty though this did not reach significance
until day 120. The rate of re-operation was significantly higher
for uncemented hemiarthroplasty. Despite adjusting for 12 confounding
variables, these only accounted for 15% of the observed variability. The debate about the choice of the method of fixation for a hemiarthroplasty
with respect to the rate of mortality or the risk of re-operation
may be largely superfluous. Our results suggest that uncemented
hemiarthroplasties may have a role to play in elderly patients with
significant co-morbid disease. Cite this article:
The surgical treatment options for patients who have sustained an intra-capsular hip fracture can vary depending on a number of patient and fracture related factors. Currently most national guidelines support the use of cemented prostheses for patient undergoing hemi-arthroplasty surgery. Uncemented prostheses are commonly used for a variety of indications including those patients who have significant medical co-morbidities. To determine whether cemented hemi-arthroplasty is associated with a higher post operative mortality when compared to uncemented procedures. Data was extracted from the Scottish SMR01 database from 01/04/1997 from all patients who were admitted to hospital after sustaining a hip fracture. We investigated mortality at day 1, 2, 4, 7, 30, 120 and 1 year from surgery vs. that on day 0. In order to control for the effects of confounding variables between patients cohorts, 12 case-mix variable were used to construct a multivariable logistic regression analysis model to determine the independent effect of prosthesis fixation method. There were 64,979 patients were included in the study. Mortality for osteosynthesis of extra-capsular fractures was consistently lower when compared to that for surgical procedures for intra-capsular fractures. At day 0, uncemented hemi-arthroplasty operations had a lower associated mortality (p<0.001) when compared to cemented implant designs. Unadjusted figures showed an increased mortality equal to 1 extra death per 424 procedures. By day 1 this had become 1 extra death per 338 procedures. By day 7 cumulative mortality was less for cemented than for uncemented procedures though this did not reach significance until day 120. When compared to uncemented fixation techniques, cemented hemiarthroplasty is associated with a higher mortality in the immediate postoperative period. However, by day 120 and beyond the trend is reversed.
The surgical treatment options for patients who have sustained an intra-capsular hip fracture can vary depending on a number of patient and fracture related factors. Currently most national guidelines support the use of cemented prostheses for patient undergoing hemiarthroplasty surgery. Uncemented prostheses are commonly used for a variety of indications including those patients who have significant medical co-morbidities. To determine whether cemented hemiarthroplasty is associated with a higher post operative mortality when compared to uncemented procedures. Data were extracted from the Scottish SMR01 database from 01/04/1997 from all patients who were admitted to hospital after sustaining a hip fracture. We investigated mortality at day 1,2,4,7,30, 120 and 1 year from surgery vs. that on day 0. In order to control for the effects of confounding variables between patients cohorts, 12 case-mix variable were used to construct a multivariable logistic regression analysis model to determine the independent effect of prosthesis design. There were 52283 patients included in the study. Mortality for osteosynthesis of extra-capsular fractures was consistently lower when compared to that for surgical procedures for intra-capsular fractures. At day 0, uncemented hemiarthroplasty had a lower associated mortality (p<0.001) when compared to cemented implant designs. However, this increased mortality was equal to 1 extra death per 2000 procedures. From day 1 onward mortality for cemented procedures was equal to or lower than that of uncemented. By day 4, cumulative mortality was less for cemented than for uncemented procedures. Complication and re-operation rate was significantly higher in the uncemented cohort. The use of uncemented hemiarthroplasty for the treatment of intra-capsular hip fractures cannot be justified in terms of early/late post-operative mortality.
To determine the long term outcome and complications associated with arthroscopic synovectomy in 22 knees with rheumatoid arthritis. A consecutive series of 22 knees in 18 patients with seropositive RA underwent arthroscopic synovectomy for painful and swollen knees unresponsive to medical treatment. All operations were performed by the senior author. The mean age at operation was 44 years (22–64). All pre-operative Xrays showed Larsen grade 2 or less and no knees demonstrated marked joint laxity. Knee Society scores were recorded pre-operatively and at review, with a mean follow-up of 8 years(6–16). Two out of 22 knees (9%) have undergone TKR at 1 and 2 years post synovectomy. Two patients underwent further synovectomy for persistent symptoms but have since remained well. No per-operative complications were recorded but one large haemarthrosis and one stiff knee requiring manipulation were seen. The mean clinical and function scores increased by 22 and 15 points respectively at follow-up. The mean length of stay was 3 days and radiographs of the 20 knees not undergoing prosthetic replacement have all shown a small progression of degenerative radiological change. This long-term study shows that arthroscopic synovectomy in appropriately selected patients with RA is a safe and reliable procedure with a low complication rate. The surgery is technically demanding but involves a shorter in-patient stay than with open synovectomy. The development of radiological degenerative changes were seen with all patients at review.
