Aseptic revisions and pulmonary embolism after surgical treatment of femoral neck fractures with cemented and cementless hemiarthroplasty in Germany: an analysis from the German Arthroplasty Registry (EPRD)

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Abstract

Background

Femoral neck fractures (FNF) are among the most common fractures in Germany and are often treated by hemiarthroplasty (HA). The aim of this study was to compare the occurrence of aseptic revisions after cemented and uncemented HA for the treatment of FNF. Secondly, the rate of pulmonary embolism was investigated.

Methods

Data collection for this study was performed using the German Arthroplasty Registry (EPRD). HAs after FNF were divided into subgroups stratified by stem fixation (cemented vs uncemented) and paired according to age, sex, BMI, and the Elixhauser score using Mahalanobis distance matching.

Results

Examination of 18,180 matched cases showed a significantly increased rate of aseptic revisions in uncemented HA ( p < 0.0001). After 1 month 2.5% of HAs with uncemented stems required an aseptic revision, while 1.5% were reported in cemented HA. After 1 and 3 years’ follow-up 3.9% and 4.5% of uncemented HA and 2.2% and 2.5% of cemented HA needed aseptic revision surgery. In particular, the proportion of periprosthetic fractures was increased in cementless implanted HA ( p < 0.0001). During in-patient stays, pulmonary emboli occurred more frequently after cemented HA [0.81% vs 0.53% in cementless HA (OR: 1.53; p = 0.057)].

Conclusion

For uncemented hemiarthroplasties a statistically significantly increased rate of aseptic revisions and periprosthetic fractures was evident within a time period of 5 years after implantation. During the in-hospital stay, patients with cemented HA experienced an increased rate of pulmonary embolism, but without statistically significant results. Based on the present results, with knowledge of prevention measurements and correct cementation technique, cemented HA should be preferred when using HA in the treatment of femoral neck fractures.

Trail registration: The study design of the German Arthroplasty Registry was approved by the University of Kiel (ID: D 473/11).

Level of Evidence: Level III, Prognostic.

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Most cited references 36

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Nonparametric Estimation from Incomplete Observations

E. Kaplan, Paul Meier (1958)

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A modification of the Elixhauser comorbidity measures into a point system for hospital death using administrative data.

P. Austin, Alison Jennings, Hude Quan … (2009)

Comorbidity measures are necessary to describe patient populations and adjust for confounding. In direct comparisons, studies have found the Elixhauser comorbidity system to be statistically slightly superior to the Charlson comorbidity system at adjusting for comorbidity. However, the Elixhauser classification system requires 30 binary variables, making its use for reporting and analysis of comorbidity cumbersome. Modify the Elixhauser classification system into a single numeric score for administrative data. For all hospitalizations at the Ottawa Hospital, Canada, between 1996 and 2008, we determined if International Classification of Disease codes for chronic diagnoses were in any of the 30 Elixhauser comorbidity groups. We then used backward stepwise multivariate logistic regression to determine the independent association of each comorbidity group with death in hospital. Regression coefficients were modified into a scoring system that reflected the strength of each comorbidity group's independent association with hospital death. Hospitalizations that were included were 345,795 (derivation: 228,565; validation 117,230). Twenty-one of the 30 groups were independently associated with hospital mortality. The resulting comorbidity score had an equivalent discrimination in the derivation and validation groups (overall c-statistic 0.763, 95% CI: 0.759-0.766). This was similar to models having all Elixhauser groups (0.760, 95% CI: 0.756-0.764) or significant groups only (0.759, 95% CI: 0.754-0.762), but significantly exceeded discrimination when comorbidity was expressed using the Charlson score (0.745, 95% CI: 0.742-0.749). When analyzing administrative data, the Elixhauser comorbidity system can be condensed to a single numeric score that summarizes disease burden and is adequately discriminative for death in hospital.

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World-wide projections for hip fracture.

B Gullberg, O. Johnell, J Kanis (1997)

The aims of this study were to estimate the present and future incidence of hip fracture world-wide. From a survey of available data on current incidence, population trends and the secular changes in hip fracture risk, the numbers of hip fractures expected in 2025 and 2050 were computed. The total number of hip fractures in men and women in 1990 was estimated to be 338,000 and 917,000 respectively, a total of 1.26 million. Assuming no change in the age- and sex-specific incidence, the number of hip fractures is estimated to approximately double to 2.6 million by the year 2025, and 4.5 million by the year 2050. The percentage increase will be greater in men (310%) than in women (240%). With modest assumptions concerning secular trends, the number of hip fractures could range between 7.3 and 21.3 million by 2050. The major demographic changes will occur in Asia. In 1990, 26% of all hip fractures occurred in Asia, whereas this figure could rise to 37% in 2025 and to 45% in 2050. We conclude that the socioeconomic impact of hip fractures will increase markedly throughout the world, particularly in Asia, and that there is an urgent need to develop preventive strategies, particularly in the developing countries.

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Author and article information

Contributors

Markus Rupp:

ORCID: http://orcid.org/0000-0001-7221-3783

markus.rupp@ukr.de

Journal

Journal ID (nlm-ta): J Orthop Traumatol

Journal ID (iso-abbrev): J Orthop Traumatol

Title: Journal of Orthopaedics and Traumatology : Official Journal of the Italian Society of Orthopaedics and Traumatology

Publisher: Springer International Publishing (Cham )

ISSN (Print): 1590-9921

ISSN (Electronic): 1590-9999

Publication date (Electronic): 22 February 2023

Publication date PMC-release: 22 February 2023

Publication date (Print): December 2023

Volume: 24

Electronic Location Identifier: 9

Affiliations

[1 ]GRID grid.411941.8, ISNI 0000 0000 9194 7179, Department of Trauma Surgery, , University Medical Centre Regensburg, ; Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany

[2 ]Deutsches Endoprothesenregister gGmbH (EPRD), Berlin, Germany

[3 ]Orthopädisch Chirurgisches Kompetenzzentrum Augsburg (OCKA), Augsburg, Germany

Author information

Markus Rupp http://orcid.org/0000-0001-7221-3783

Article

Publisher ID: 689

DOI: 10.1186/s10195-023-00689-4

PMC ID: 9947202

PubMed ID: 36811821

SO-VID: ba7ea23f-c85d-4d24-b22b-9d352cbdac5a

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 23 October 2022

Date accepted : 4 February 2023

Funding

Funded by: Universitätsklinikum Regensburg (8921)

Open Access :

Open Access funding enabled and organized by Projekt DEAL.

Custom metadata

ScienceOpen disciplines: Orthopedics

Keywords: femoral neck fracture,hemiarthroplasty,embolism,revision,arthroplasty registry,cementing

Data availability:

ScienceOpen disciplines: Orthopedics

Keywords: femoral neck fracture, hemiarthroplasty, embolism, revision, arthroplasty registry, cementing

Aseptic revisions and pulmonary embolism after surgical treatment of femoral neck fractures with cemented and cementless hemiarthroplasty in Germany: an analysis from the German Arthroplasty Registry (EPRD)

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Most cited references 36

Nonparametric Estimation from Incomplete Observations

A modification of the Elixhauser comorbidity measures into a point system for hospital death using administrative data.

World-wide projections for hip fracture.

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Contributors

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Affiliations

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