Increasing Use of Cemented Stems Is Associated With Reduced Early Fracture After Total Hip Arthroplasty: A Michigan Arthroplasty Registry Collaborative Quality Initiative Study.

Abstract

The Michigan Arthroplasty Registry Quality Collaborative Initiative (MARCQI) identified periprosthetic fracture as the most common reason for early total hip arthroplasty (THA) revision of uncemented hips. This analysis described a state-wide quality improvement project to reduce fracture and early revision. The MARCQI reports data to participants through reports and in-person meetings and incorporated postoperative hip fracture into pay-for-performance incentives as part of a quality improvement project in 2018. The percent of cemented stems and incidence of fracture within 90 days of surgery were analyzed by age, sex, and year of surgery. The overall use of cemented stems in THA rose from 2.7% in 2017 to 6.8% in 2022. Only 0.7% of men and 1.8% of women under 75 years were cemented in 2017 while 4.7 and 10.4% of patients 75 years and older were cemented, respectively. By 2022, 10.8% of men and 26.8% of women 75 years and older were cemented. In elderly women, the incidence of fracture after THA has dropped to 1.7% in 2022 from a peak of 3.5% in 2018 as the use of cement has increased. Early fracture often leads to revision and may be preventable. This analysis demonstrated a direct correlation between the use of cemented stems and decreased postoperative fracture rates in elderly women. State-wide fractures increased from 2012 to 2018 (peak at 1.3%). Since the beginning of the MARCQI fracture reduction quality initiative, there has been a steady decline to 0.96% in 2022. Stratifying by age and sex, cementing in older women increased by 16%, and fracture rates decreased by nearly 2%. With this MARCQI initiative, there were an estimated 280 fewer revisions secondary to fractures in Michigan. Surgeons should consider using cemented femoral stems for THA in elderly women.