Shall We Not Pressurise It? Effects of Bone Cement Pressurisation on Mortality and Revision Following Hip Hemiarthroplasty for Neck of Femur Fracture Patients: A Comparative Cohort Study.

Abstract

OBJECTIVES This study aimed to compare 30-day post-operative mortality, and revision for aseptic femoral component loosening and all-causes following hip hemiarthroplasty performed with or without pressurisation of the bone cement in neck of femur fracture patients. METHODS Design: Retrospective cohort study. SETTING Level I trauma center. PATIENT SELECTION CRITERIA Patients ≥60 years with OTA/AO 31B who underwent a cemented hip hemiarthroplasty from 10th December 2007 (database inception) to 15th November 2023 (search date) were reviewed.Outcome Measures and Comparisons: Comparisons were made between patients who underwent hip hemiarthroplasty with versus without pressurisation of the bone cement for outcomes 30-day post-operative mortality, revision for aseptic femoral component loosening, and revision for all-causes. RESULTS 406 procedures among 402 patients, and 722 procedures among 713 patients were performed with and without pressurisation of the bone cement respectively. Mean ages were 83.1 and 84.3 years (p=0.018), with 72.2% and 68.6% (p=0.205) females in the pressurised and non-pressurised cement patient groups respectively. There were no differences in 30-day post-operative mortality (7.2% versus 8.2%; HR 0.89, 95%CI 0.46-1.73, p=0.727). There were no differences in all-cause revision (HR 1.04, 95%CI 0.27-4.04, p=0.953). No revisions were performed for aseptic loosening. Survival at 10 years post-operatively was 15.3% (95%CI 11.46-19.64) and 12.6% (95%CI 7.67-18.82) among patients who underwent hemiarthroplasty with and without bone cement pressurisation respectively. CONCLUSIONS There were no differences in 30-day post-operative mortality among patients who underwent hemiarthroplasty with, compared to, without bone cement pressurisation. Bone cement pressurisation did not confer any advantages for revision outcomes which may be attributed in part to patients' high mortality rate and low survival beyond 10 years post-operatively. LEVEL OF EVIDENCE Level III. See Instructions for Authors for a complete description of levels of evidence.