CEMENTING HIP FRACTURES AS THE STANDARD OF CARE: ESTABLISHING THE CONSENSUS IN CANADA?

Despite the evidence supporting the use of cemented over non-cemented femoral stem fixation for treating hip fractures, there is still variation in its application. This paper looks at current trends in Canada using Canadian Joint Replacement Registry data and includes a national survey to understand the varied uptake in the use of cement for femoral stem fixation, aiming to discuss and explore ways to improve the quality of care for hip fracture patients. The Canadian Arthroplasty Society approved this national survey before the Canadian Orthopaedic Association endorsed it for distribution to its members. The survey was available online through Qualtrics, and the website link was distributed via email through the Canadian Orthopaedic Association to all orthopaedic surgeons across Canada. All survey responses remained anonymous. The survey was open for submissions between September and December of 2022. The survey was distributed to 1600 individuals and received 106 responses (response rate of 7%). Respondents’ location of practice varied; Ontario was the most common (40%), followed by Quebec (12.3%). Most respondents practiced in an academic community setting (52%). The number of respondents who reported using cement was roughly equal, with 53% responding ‘yes’ and 47% responding ‘no.’ 71% of respondents indicated that cemented femoral fixation was best practice, 27% indicated that both cemented/uncemented were acceptable, and 2% indicated that uncemented was best practice. Respondents cited various reasons for the selection of uncemented fixation, with the most common ones being less operative time (23%), cement disease concerns (11%), and surgeons’ comfort (10%). This Canadian study demonstrates equivalent use of cemented and cementless implants for femoral stem fixation despite solid evidence demonstrating improved clinical outcomes with cement. Some of the main reasons cited by respondents in favour of uncemented technique include operative time, surgical training, and concern about cement disease. Establishing clear position statements and clinical practice guidelines supporting cemented femoral stem fixation may be prudent to build universal consensus on this practice.