Identifying Mortality Risk Factors In Cemented Hip Hemiarthroplasty

Introduction

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.

Method

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.

Results

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.

Conclusion

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.

 

Download original document Hip_hemi_Poster.pdf

 

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