A Discrepancy Between Evidence and Practice: Underuse of Cemented Hemiarthroplasty for Femoral Neck Fractures and Its Association With Surgeon Training Background.

Abstract

Despite extensive evidence demonstrating lower complications with cemented hip hemiarthroplasty (HHA), many orthopaedic surgeons continue to use noncemented HHA implants for the management of femoral neck fractures in elderly populations. In this study, we aimed to validate these findings within our cohort and to examine whether this evidence is reflected in current surgical practice. We conducted a retrospective cohort study of patients aged older than 50 years who underwent HHA for intracapsular femoral neck fractures between 2009 and 2018 across a multicenter hospital system. Intraoperative and postoperative surgical complications were compared between cemented and noncemented implants. Surgeon data, including fellowship training and case volume, were collected to assess associations with implant selection. A total of 4407 patients (mean age 81 years, mean follow-up 4106 days) were included, with 496 (11%) receiving cemented and 3911 (89%) noncemented HHA. Intraoperative and postoperative periprosthetic fractures were significantly lower in the cemented group (HR = 0.57, 95% CI, 0.32-0.82, P = 0.047; and HR = 0.39, 95% CI, 0.17-0.77, P = 0.021, respectively). Use of cemented over noncemented HHA was significantly higher among trauma surgeons (36.4%) compared with arthroplasty surgeons (4.3%, P = 0.012), and general orthopaedic surgeons or surgeons with nonrelated fellowship training (7.1%, P = 0.029). Consistent with previous studies, our findings reaffirm the superior clinical outcomes of cemented HHA. Nevertheless, noncemented implants remained the predominant choice within our hospital system-even among fellowship-trained surgeons. This highlights a persistent gap between evidence and practice, emphasizing the need for stronger integration of evidence-based guidelines into surgical decision making. Level III.