Is there benefit for using smooth tapered cemented hemiarthroplasties in ASA grade 3 and 4 patients

Abstract

Following the recommendation of NICE guidelines (CG124) we have recently started using cemented smooth tapered stem hemiarthroplasty as our standard management of intra-capsular neck of femur fractures. Prior to publication of the above guidelines the standard implant utilised was Thompson Hemiarthroplasty prosthesis. The cost implications of this change have not been fully appreciated and the benefit of these changes in ASA grade 3–4 patients has not previously been analysed. We identified a cohort of 89 patients admitted with displaced intra-capsular neck of femur fracture with an ASA grade 3–4. These underwent hip hemiarthroplaties at our centre over a period of 12 months (before and after guideline implementation). Data regarding in-hospital mortality, dislocation, reoperation and place of discharge were retrospectively collected and analysed. Our cohort included 46 patients who underwent a Thompsons Hemiarthroplasty, 30 patients who had a cemented smooth tapered stem hemiarthroplasty and 13 patients who had an Austin-moore Hemiarthroplasty. In-patient mortality rates were highest in the Austin-moore group, followed by the Thompsons group compared to none in the smooth tapered stem group. However, this was not statistically significant. One patient in the Thompsons group and one patient in the smooth tapered group had multiple dislocations and re-operations, compared with none in the Austin-moore group. In terms of percentage of patients who were discharged home from hospital the smooth tapered stem group had a percentage that was more than twice that of the Thompson9s which was in turn higher than that found in the Austin-moore group. In conclusion, our data suggests that in patients with an ASA grade of 3–4 there is no significant benefit from using cemented smooth tapper stems when performing a Hip Hemiarthroplasty compared with a well performed Thompsons and that the cost savings of this is significant. We accept that our current numbers are relatively small and further work is needed.