Increased associated risk of postoperative periprosthetic femur fracture with cementless versus cemented hemiarthroplasty: a nationwide database study of 24,419 femoral neck fractures.

Objective: We evaluated the associated risk of postoperative periprosthetic femur fracture after hemiarthroplasty for the treatment of femoral neck fracture based on stem fixation, cementless compared with cemented. Design: A retrospective review of patient data from the PearlDiver database from 2015 to 2020. Setting: This database is comprised of 140 million deidentified patients based on national all-claims data including Medicare, Medicaid, government and private insurance. Patients/Participants: We identified 24,468 patients with hemiarthroplasty for treatment of femoral neck fracture from 2015 to 2020. Demographic data included; age, sex, diagnosis of obesity, and Charlson Comorbidity Index. Intervention: We identified postoperative periprosthetic femur fracture as our primary outcome and stratified femoral fixation as cemented 12,777 (52.2%) or cementless 11,691 (47.8%). Main Outcome Measurements: Propensity matched analysis with odds ratios (OR) was performed to evaluate association between fixation and odds of postoperative periprosthetic femur fracture; multivariate analysis was used to adjust for demographic characteristics and comorbidities. Results: Cementless fixation was associated with increased odds of post-operative periprosthetic femur fracture (OR 3.32 [95% confidence interval (CI), 2.75-4.00]; Conclusions: We noted increased associated risk of postoperative periprosthetic femur fracture with cementless femoral fixation for hemiarthroplasty to treat femoral neck fracture, particularly in females. The risk of postoperative periprosthetic femur fracture should be considered as surgeons choose femoral fixation for hemiarthroplasty in the treatment of femoral neck fracture. Level of Evidence: Therapeutic Level III.