Department of Orthopaedic Surgery and Traumatology, Hospital Lillebaelt, University Hospital of Southern Denmark, Kolding, Denmark.
Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.
Bone Joint J. 2022 Jan;104-B(1):127-133. doi: 10.1302/0301-620X.104B1.BJJ-2021-0523.R1.
The aim of this study was to assess the association of mortality and reoperation when comparing cemented and uncemented hemiarthroplasty (HA) in hip fracture patients aged over 65 years.
This was a population-based cohort study on hip fracture patients using prospectively gathered data from several national registries in Denmark from 2004 to 2015 with up to five years follow-up. The primary outcome was mortality and the secondary outcome was reoperation. Hazard ratios (HRs) for mortality and subdistributional hazard ratios (sHRs) for reoperations are shown with 95% confidence intervals (CIs).
A total of 17,671 patients with primary HA were identified (9,484 uncemented and 8,187 cemented HAs). Compared to uncemented HA, surgery with cemented HA was associated with an absolute risk difference of 0.4% for mortality within the period zero to one day after surgery and an adjusted HR of 1.70 (95% CI 1.22 to 2.38). After seven days, there was no longer any association, with an adjusted HR of 1.07 (95% CI 0.90 to 1.28). This continued until five years after surgery with a HR of 1.01 (95% CI 0.96 to 1.06). There was a higher proportion of reoperations due to any reason after five years in the uncemented group with 10.2% compared to the cemented group with 6.1%. This yielded an adjusted sHR of 0.65 (95% CI 0.57 to 0.75) and difference continued up until five years after the surgery, demonstrating a sHR of 0.70 (95% CI 0.59 to 0.83).
In a non-selected cohort of hip fracture patients, surgery with cemented HA was associated with a higher relative mortality during the first postoperative day compared to surgery with uncemented HA, but there was no difference after seven days up until five years after. In contrast, surgery with cemented HA was associated with lower risk of reoperation up to five years postoperatively compared with surgery with uncemented HA. There was a higher relative mortality on the first postoperative day for cemented HA versus uncemented HA. There was no difference in mortality after seven days up until five years after surgery. There were 6.1% reoperations for cemented HA compared to 10.2% for uncemented HA after five years. Cite this article: 2022;104-B(1):127-133.
本研究旨在比较 65 岁以上髋部骨折患者行骨水泥型与非骨水泥型半髋关节置换术（HA）的死亡率和翻修率。
本研究为基于人群的队列研究，使用丹麦多个国家登记处前瞻性收集的 2004 年至 2015 年的数据，随访时间最长为 5 年。主要结局为死亡率，次要结局为翻修率。采用风险比（HR）和亚分布风险比（sHR）表示死亡率和翻修率，并给出 95%置信区间（CI）。
共纳入 17671 例行初次 HA 手术的患者（非骨水泥型 9484 例，骨水泥型 8187 例）。与非骨水泥型 HA 相比，骨水泥型 HA 术后 0-1 天的绝对死亡风险增加 0.4%，校正 HR 为 1.70（95%CI 1.22-2.38）。术后 7 天，无显著相关性，校正 HR 为 1.07（95%CI 0.90-1.28）。直至术后 5 年，HR 仍为 1.01（95%CI 0.96-1.06）。术后 5 年时，非骨水泥组因任何原因行翻修术的比例高于骨水泥组，分别为 10.2%和 6.1%。校正后 sHR 为 0.65（95%CI 0.57-0.75），直至术后 5 年差异仍持续存在，sHR 为 0.70（95%CI 0.59-0.83）。
在非选择性髋部骨折患者队列中，与非骨水泥型 HA 相比，骨水泥型 HA 术后第 1 天的相对死亡率更高，但术后 7 天至 5 年内无差异。相反，与非骨水泥型 HA 相比，骨水泥型 HA 术后 5 年内翻修风险较低。骨水泥型 HA 术后第 1 天的相对死亡率高于非骨水泥型 HA。术后 7 天至 5 年内，死亡率无差异。术后 5 年时，骨水泥型 HA 的翻修率为 6.1%，而非骨水泥型 HA 为 10.2%。
