FIXATION IN ARTHROPLASTY FOR HIP FRACTURES: CANADIAN TRENDS FOR SURGEONS AND HOSPITALS

Cemented fixation is now widely recommended in arthroplasty for hip fractures, although these recommendations are not universally followed. In Canada, only 60% of hemiarthroplasties for hip fractures are cemented. We aimed to understand which surgeons and hospitals are less likely to cement in order to understand where advocacy should be focused. We included all patients 55 years-old or over, who were included in the Canadian Joint Replacement Registry (CJRR) and who had a total hip arthroplasty or hemiarthroplasty for an acute hip fracture between April 1, 2012 and March 31, 2022. We obtained cementing status from the CJRR and information on the surgeon and hospital by linking the CJRR with physician billing information and hospital records. Surgeon information was only available from April 1, 2018 onward. We classified surgeons into low- and high-volume arthroplasty surgeons (≥50 hip arthroplasties/year); we further classified the high-volume surgeons into low and high hip fracture volume (≥16 hip fracture cases/year). We classified hospitals as teaching hospitals, based on provincial ministries submissions, or community hospitals; we further classified hospital by number of hip arthroplasties (≥500) and proportion for hip fractures (over/under 25%). As guidelines on cementing were implemented during this period, we analyzed 3 periods (2012/13-2015/16, 2016/17-2018/19, and 2019/20-2021/22). We used logistic regression to measure the odds ratios (ORs) and confidence intervals (CIs) of the association between surgeon/hospital characteristics and cemented fixation while adjusting for patient age, gender, comorbidity, and province. We identified 65,914 hip fracture patients, around two-thirds were 80+ years-old. The proportion of patients with cemented fixation generally increased over time for every hospital group. Community hospitals were consistently less likely to use cement than teaching hospitals: OR=0.85 (95% CI 0.81–0.90) in 2019/20-2021/22. Hospitals with a high volume of hip fractures (≥500 hips/year, ≥25% hips for fractures) had an OR of 0.43 (95% CI 0.38–0.84) for use of cemented fixation compared to low-volume elective hospitals (Roughly half of patients were operated on by low-volume surgeons. High-volume hip fracture surgeons treated around 60% of the remaining patients. Low-volume surgeons operated in teaching hospitals for 37% of their cases versus 29% for high-volume surgeons. High-volume hip fracture surgeons were least likely to use cement, OR = 0.76 (95% CI 0.72–0.80) compared to low-volume surgeons. Our results indicate that surgeons and hospitals with the highest volumes of hip fracture arthroplasties are least likely to follow recommendations on cement use. A better understanding of their rationale is needed to understand how to close this gap.