The Impact of Femoral Component Cementation on Fracture and Mortality Risk in Elective Total Hip Arthroplasty: Analysis from a National Medicare Sample.
The Impact of Femoral Component Cementation on Fracture and Mortality Risk in Elective Total Hip Arthroplasty: Analysis from a National Medicare Sample.
复制标题
DOI：
10.2106/jbjs.21.00640
复制
发表时间：
2022-03-16
期刊：
影响因子：
--
通讯作者：
Dillingham TR
中科院分区：
文献类型：
--
作者：
Edelstein AI;Hume EL;Pezzin LE;McGinley EL;Dillingham TR
择期全髋关节置换术（THA）后的并发症很少见，但可能具有破坏性。尚未在美国全国代表性人群中研究股骨部件骨水泥固定对假体周围股骨骨折和早期围手术期死亡风险的影响。从2017年至2018年的医疗保险索赔中确定了在老年患者中使用或不使用骨水泥进行的择期初次THA。我们对年龄、性别、种族/民族、合并症、支付模式、机构人口普查部门和暴露时间进行了1：2匹配的单独巢式病例对照分析，并比较了（1）有和无90天假体周围股骨骨折组和（2）有和无30天死亡率组之间的固定模式。共纳入118，675个临屋区。90天假体周围股骨骨折率为2.0%，30天死亡率为0.18%。病例配对成功。骨水泥固定的女性患者假体周围股骨骨折的风险显著低于非骨水泥固定的匹配对照组（OR = 0.83; 95% CI，0.69 - 1.00; p = 0.05）;男性患者中该结果不明显（p = 0.94）。相反，骨水泥固定男性患者的30天死亡风险高于非骨水泥固定的匹配对照组（OR = 2.09; 95% CI，1.12 - 3.87; p = 0.02）。女性患者中骨水泥使用与死亡率之间的相关性几乎达到显著性（OR = 1.74; 95% CI，0.98 - 3.11; p = 0.06）。在接受THA治疗的老年患者中，女性患者的骨水泥型股骨柄与假体周围股骨骨折的发生率较低相关，但男性患者则不然。骨水泥型股骨柄与30天死亡率较高之间的相关性在男性患者中显著，在女性患者中几乎达到显著性，尽管绝对死亡率非常低。对于能够胜任使用骨水泥进行THA的外科医生，我们的数据支持使用骨水泥型股骨柄来避免老年女性患者的假体周围股骨骨折。治疗水平III。有关证据等级的完整描述，请参见作者说明。
Complications following elective total hip arthroplasty (THA) are rare but potentially devastating. The impact of femoral component cementation on the risk of periprosthetic femoral fractures and early perioperative death has not been studied in a nationally representative population in the United States. Elective primary THAs performed with or without cement among elderly patients were identified from Medicare claims from 2017 to 2018. We performed separate nested case-control analyses matched 1:2 on age, sex, race/ethnicity, comorbidities, payment model, census division of facility, and exposure time and compared fixation mode between (1) groups with and without 90-day periprosthetic femoral fracture and (2) groups with and without 30-day mortality. A total of 118,675 THAs were included. The 90-day periprosthetic femoral fracture rate was 2.0%, and the 30-day mortality rate was 0.18%. Cases were successfully matched. The risk of periprosthetic femoral fracture was significantly lower among female patients with cement fixation compared with matched controls with cementless fixation (OR = 0.83; 95% CI, 0.69 to 1.00; p = 0.05); this finding was not evident among male patients (p = 0.94). In contrast, the 30-day mortality risk was higher among male patients with cement fixation compared with matched controls with cementless fixation (OR = 2.09; 95% CI, 1.12 to 3.87; p = 0.02). The association between cement usage and mortality among female patients almost reached significance (OR = 1.74; 95% CI, 0.98 to 3.11; p = 0.06). In elderly patients managed with THA, cemented stems were associated with lower rates of periprosthetic femoral fracture among female patients but not male patients. The association between cemented stems and higher rates of 30-day mortality was significant for male patients and almost reached significance for female patients, although the absolute rates of mortality were very low. For surgeons who can competently perform THA with cement, our data support the use of a cemented stem to avoid periprosthetic femoral fracture in elderly female patients. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.