Department of Orthopaedic Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
Arch Orthop Trauma Surg. 2024 Jun;144(6):2673-2681. doi: 10.1007/s00402-024-05382-7. Epub 2024 Jun 4.
Cemented hip hemiarthroplasty is a routine surgical option for elderly neck of femur (NOF) fractures. It is uncertain if quality of cementing has any effect on functional outcomes. The aim of this study was to determine if the quality of cementing would affect short term functional outcomes in elderly neck of femur fractures.
Retrospective analysis of 637 single-centre cemented hip hemiarthroplasties from 2014 to 2021 was performed. Each post-operative radiograph was double-read by 2 authors (1 resident and 1 fellowship trained surgeon) to determine quality of cementing via the Barrack grading. Disagreements were reviewed by a third reader. Cement grades were grouped as Optimal (Barrack grade A-B), or Suboptimal (Barrack grade C-D). Functional outcomes were compared using mobility (community- or home-ambulant), assistance required for mobility, and Modified Barthel Index (MBI). Surgical parameters were compared between the groups.
There were 429 Optimal and 208 Suboptimal cases of cementing performed. There was no difference in age, American Society of Anesthesiologists score, mobility, assistance required, and MBI score pre-operatively (p > 0.05). Patients in the "Suboptimal" cementing group had a higher Charlson Comorbidity Index (CCI) score (p < 0.001). At 1 year post-operation, there was no significant difference between "Optimal" and "Suboptimal" cementing with regards to the proportion of community ambulators (30.2% vs. 25.7%, p = 0.252), walking independence (independent walkers (19.8% vs.17.3%), independent walkers with aids (41.3%vs.42.1%), walker with caregiver assistance (29.2%vs.33.7%), wheelchair-bound (9.6%vs.6.9%), p = 0.478), and distribution of MBI score (81.1%vs.82.2% achieving MBI > 60, p = 0.767). There was no significant difference in the proportion of patients with postoperative delirium (7.9% vs. 5.8, p = 0.324) or 1-year mortality rates (3.5% vs. 2.9%, p = 0.685). Except for stem design (12.2% tapered vs 20.1% collared; p = 0.011), no other surgical parameters were significantly different. The kappa value for inter-reader agreement was "substantial" at 0.727 (95% CI 0.682-0.772) (p < 0.001).
Quality of cementing in cemented hip hemiarthroplasty for elderly NOF fractures does not affect the short-term functional outcomes. In low demand patients and patients at risk of BCIS, optimal cementing may not be necessary to achieve similar short-term functional outcomes. Further studies should be conducted to determine the effect of sub-optimal cementing on long-term functional outcomes.
对于老年股骨颈（NOF）骨折，骨水泥固定髋关节半髋关节置换术是一种常规的手术选择。目前尚不确定骨水泥的质量是否会影响功能结果。本研究旨在确定老年股骨颈骨折中骨水泥的质量是否会影响短期功能结果。
回顾性分析了 2014 年至 2021 年期间在单一中心进行的 637 例骨水泥固定髋关节半髋关节置换术。每位术后患者的 X 线片均由 2 位作者（1 位住院医师和 1 位接受 fellowship 培训的外科医生）进行双次阅读，以通过 Barrack 分级确定骨水泥的质量。分歧由第三位读者进行审查。水泥等级分为“理想”（Barrack 等级 A-B）或“不理想”（Barrack 等级 C-D）。使用移动性（社区或家庭活动）、移动所需的辅助以及改良 Barthel 指数（MBI）来比较功能结果。在组间比较手术参数。
有 429 例骨水泥固定为理想状态，208 例为不理想状态。在年龄、美国麻醉师协会评分、移动性、辅助需求和术前 MBI 评分方面（p>0.05），两组之间没有差异。“不理想”骨水泥固定组的 Charlson 合并症指数（CCI）评分较高（p<0.001）。术后 1 年，“理想”和“不理想”骨水泥固定在社区活动者的比例方面没有显著差异（30.2%比 25.7%，p=0.252）、独立行走者（19.8%比 17.3%）、辅助独立行走者（41.3%比 42.1%）、助行器行走者（29.2%比 33.7%）、轮椅使用者（9.6%比 6.9%），p=0.478）以及 MBI 评分的分布（81.1%比 82.2%的患者达到 MBI>60，p=0.767）。术后谵妄（7.9%比 5.8%，p=0.324）或 1 年死亡率（3.5%比 2.9%，p=0.685）的患者比例没有显著差异。除了柄设计（12.2%锥形比 20.1%带颈；p=0.011）外，其他手术参数没有显著差异。两位读者之间的kappa 值为“中等”，为 0.727（95%CI 0.682-0.772）（p<0.001）。
在治疗老年股骨颈骨折的骨水泥固定髋关节半髋关节置换术中，骨水泥的质量并不影响短期功能结果。在低需求患者和有 BCIS 风险的患者中，为了达到类似的短期功能结果，可能不需要理想的骨水泥固定。应进一步开展研究，以确定次优骨水泥固定对长期功能结果的影响。
