Cemented fixation in arthroplasty for HIP fractures and adverse outcomes: a secondary analysis of the HIP attack trial
Abstract
The use of cemented fixation is widely recommended when hip arthroplasty is used to treat hip fractures. Some argue that the risk of bone cement implantation syndrome (BCIS), characterized by cardiovascular collapse at the time of cementing and pressurization, is so high it does not warrant the use of bone cement to reduce revision risk. We aimed to assess the association between cemented fixation and mortality and cardiopulmonary morbidity to assess this risk in a secondary analysis of data collected during the HIP ATTACK randomized clinical trial.
The HIP ATTACK trial, was a 2,970-patient trial in which patients with a hip fracture that required surgery were randomized to accelerated surgery or standard care. We included all patients enrolled in the HIP ATTACK trial who had hemiarthroplasty or total hip arthroplasty for femoral neck fractures and who had their fixation status recorded. Due to the retrospective nature of this secondary analysis, we did not collect any additional data. Fixation was recorded in the trial data, as were mortality and morbidity after 90 postoperative days. We created a composite outcome, reflective of the cardiopulmonary risk factors associated with BCIS: all-cause mortality, myocardial infarction, stroke, congestive heart failure, new atrial fibrillation, coronary revascularization, venous thromboembolism, and pneumonia. We used logistic regression to measure the odds ratio (OR) of the association between cemented fixation and this composite…
How strong is the evidence?
Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 966 participants or records.
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