Fixation of intracapsular displaced neck of femur fractures are commonly managed with cemented hip hemiarthroplasty. However there is evidence to show that there is a substantial risk of mortality associated with this procedure. Our aim was to find factors contributing to peri-operative mortality following cemented hip hemiarthroplasty.
We analysed 94 consecutive patients who underwent cemented hemiarthroplasties (Thompsons) for displaced neck of femur fractures in 2008. All hemiarthroplasty cases were from a busy district general hospital and were cross-referenced with the national hip fracture database registry. We considered factors such as ASA grade, pre-morbid conditions, pre and post operative early warning scores (EWS) and post-operative events.
The mean age of patient was 83.3 years, range 41 to 99 years. The overall mortality rate within 28 days was 12.8%. The risk of mortality was greater with increasing ASA grade. ASA grade 4 had a 27% risk of peri-operative mortality. We found that patients with a past medical history of cardiac disease such as dysrhythmia or left ventricular failure (LVF) had a 30% risk of peri-operative death.
Those with ischaemic heart disease (IHD) or COPD had a 20% risk. Patients with two or more of these pre-morbid conditions had a 33% risk of mortality.
This study has identified and quantified patients who are at higher risk post-operatively following cemented hip hemiarthroplasty. Using these results, we feel that this ‘at risk’ sub-group need increased pre-operative optimisation as well as higher levels of care (i.e. HDU) both pre- and post-operatively. We feel that these results may justify further investigation into the use of uncemented implants in these patients.
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