Diaz Dilernia Fernando, Bohm Eric, Wood Gavin C A
Adult Hip and Knee Reconstructive Surgery, Division of Orthopaedic Surgery, Department of Surgery, Queen's University & Kingston Health Sciences Centre, Kingston, ON K7L 2V7, Canada.
Concordia Hip & Knee Institute, Concordia Joint Replacement Group, Suite 310-1155 Concordia Ave, Winnipeg, MB R2K 2M9, Canada.
J Clin Med. 2025 Aug 4;14(15):5463. doi: 10.3390/jcm14155463.
: This study examines current trends in Canada using data from the Canadian Joint Replacement Registry (CJRR) and includes a national survey to understand the varied uptake of cement for femoral stem fixation. : The survey was available online and the website link was distributed to all orthopaedic surgeons through the Canadian Orthopaedic Association between September and December 2022. The CJRR obtained data from the Canadian Institute for Health Information (CIHI), and information pertaining to patients 55 years of age and older who underwent hemiarthroplasty for hip fracture in Canada between April 2017 and March 2022 was used. : Most respondents practiced in an academic community setting (52%). Only 53% of respondents reported using cement, and 71% indicated that cemented fixation was the best practice. The main reasons for using uncemented stems were less operative time (23%), cement disease concerns (11%), and surgeons' comfort (10%). Similarly, CJRR data showed only 51% cemented fixation among 42,386 hemiarthroplasties performed between 2017 and 2022. The proportion of cemented implants varied by province, but overall, the increase in the use of cement from 2017 to 2022 was from 42.9% to 57.7%. : This study demonstrates variability in the use of cement for femoral fixation despite solid evidence showing improved outcomes using cement. Some of the main reasons in favour of uncemented stems include operative time, surgical training, and concerns about cement disease. Establishing clear position statements and guidelines supporting cemented fixation may be prudent to build universal consensus on this practice.
本研究利用加拿大关节置换登记处（CJRR）的数据考察了加拿大当前的趋势，并开展了一项全国性调查，以了解股骨柄固定中骨水泥使用情况的差异。该调查可在线获取，网站链接于2022年9月至12月期间通过加拿大骨科协会分发给了所有骨科医生。CJRR从加拿大卫生信息研究所（CIHI）获取数据，并使用了2017年4月至2022年3月期间在加拿大接受髋部骨折半关节置换术的55岁及以上患者的相关信息。大多数受访者在学术社区环境中执业（52%）。只有53%的受访者报告使用骨水泥，71%的受访者表示骨水泥固定是最佳做法。使用非骨水泥柄的主要原因是手术时间较短（23%）、担心骨水泥病（11%）以及外科医生的舒适度（10%）。同样，CJRR数据显示，在2017年至2022年期间进行的42386例半关节置换术中，只有51%采用了骨水泥固定。骨水泥植入物的比例因省份而异，但总体而言，2017年至2022年期间骨水泥使用量的增长幅度为从42.9%至57.7%。本研究表明，尽管有确凿证据表明使用骨水泥可改善疗效，但在股骨固定中骨水泥的使用仍存在差异。支持使用非骨水泥柄的一些主要原因包括手术时间、外科培训以及对骨水泥病的担忧。制定明确的立场声明和支持骨水泥固定的指南，对于就这一做法达成普遍共识可能是审慎之举。
