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Concerns have been reported to the United Kingdom National Patient Safety Agency, warning that cementing the femoral component during hip replacement surgery for fracture of the proximal femur may increase peri-operative mortality. The National Hip Fracture Database collects demographic and outcome data about patients with a fracture of the proximal femur from over 100 participating hospitals in the United Kingdom. We conducted a mixed effects logistic regression analysis of this dataset to determine whether peri-operative mortality was increased in patients who had undergone either hemiarthroplasty or total hip replacement using a cemented femoral component. A total of 16,496 patients from 129 hospitals were included in the analysis, which showed a small but significant adjusted survival benefit associated with cementing (odds ratio 0.83, 95% confidence interval 0.72 to 0.96). Other statistically significant variables in predicting death at discharge, listed in order of magnitude of effect, were gender, American Society of Anesthesiologists grade, age, walking accompanied outdoors and arthroplasty. Interaction terms between cementing and these other variables were sequentially added to, but did not improve, the model. This study has not shown an increase in peri-operative mortality as a result of cementing the femoral component in patients requiring hip replacement following fracture of the proximal femur.

Original publication




Journal article


The Journal of bone and joint surgery. British volume

Publication Date





1405 - 1410


University of Warwick, Clinical Sciences Building, Clifford Bridge Road, Coventry CV2 2DX, UK.


Femur, Humans, Femoral Neck Fractures, Arthroplasty, Replacement, Hip, Cementation, Epidemiologic Methods, Sex Factors, Age Distribution, Aged, Aged, 80 and over, Middle Aged, Female, Male, United Kingdom