The role of routine postoperative laboratory tests following hip hemiarthroplasty for an elderly femoral neck fracture

Background Performing postoperative laboratory tests following joint arthroplasty is a regular practice. However, the role of routine postoperative laboratory tests in primary hip arthroplasty is currently in doubt. This study aimed to assess the role of routine postoperative laboratory tests for femoral neck fractures in elderly patients who underwent hip hemiarthroplasty and to evaluate the risk factors for postoperative laboratory testing abnormalities and related interventions. Methods This retrospective study reviewed 735 consecutive patients with femoral neck fractures (FNFs) who underwent hip hemiarthroplasty at a single tertiary academic organization. Patient characteristic features and laboratory testing values were recorded. Logistic regression models were calculated to identify risk factors. Results A total of 321 elderly patients (> 75 years of age) were ultimately enrolled for analysis. Abnormal postoperative laboratory tests were found in 265 patients (82.6%). Only a minority of the included patients (7.5%) needed medical intervention to treat postoperative laboratory testing abnormalities. Multivariate logistic regression analysis reported that a higher Charlson comorbidity index (CCI) (P = 0.03), abnormal preoperative haemoglobin level (P < 0.01), higher intraoperative blood loss (P < 0.01) and less frequent tranexamic acid use (P = 0.05) were risk factors for abnormal postoperative laboratory tests. Furthermore, a higher CCI has been identified as a risk factor for patients needing clinical interventions related to laboratory abnormalities. Conclusions Because 92.5% of laboratory tests did not influence postoperative management, the authors suggest that routine laboratory tests after hip hemiarthroplasty for FNFs are less instructive for the majority of elderly patients. Nevertheless, for patients with identified risk factors, postoperative laboratory tests are still required to identify the abnormalities that need to be managed.

352 Did the Discontinuation of Pulse-Lavage Have A Detrimental Effect on The Quality of Hip Hemiarthroplasties Performed During the First COVID-19 Wave?

Introduction The standard of practice for performing hip hemiarthroplasty is to thoroughly wash and dry the femur with pulse-lavage. With the COVID-19 pandemic we were issued with guidance to minimise Aerosol Generating Procedures (AGPs) and discontinued the use of pulse lavage. Instead, we used a bladder syringe to wash the femoral canal. Method We retrospectively assessed 100 post-operative radiographs following hemiarthroplasties for neck of femur fractures. We used the Barrack classification to assess the bone cement mantle which is an indicator of aseptic loosening. We assessed 50 radiographs pre-covid (using pulse lavage) and 50 radiographs during covid (without pulse lavage). Results Pre-COVID-19, 30% of hemiarthroplasties were deemed as being ‘at risk’. During COVID-19, 64% of hips were deemed as being ‘at risk’. This represents an absolute increase of 34%. Conclusions This forced service change had a detrimental effect on the quality of the bone cement mantle following hip hemiarthroplasty. We recommend following these patients up at 2 years to assess for signs of aseptic loosening. In future pandemics, we recommend carefully weighing up the dangers of using AGPs against the detriment in patient outcomes likely to be experienced.

Modern cemented Furlong hemiarthroplasty: Are dislocations rates better?

Background Dislocation following hip hemiarthroplasty is a major complication with increased mortality and morbidity. Data looking at dislocation following contemporary bipolar stems are lacking in literature. Methods Retrospective review of our prospective national hip fracture database over a two-year period. Group 1 comprised of consecutive patients receiving bipolar Furlong prosthesis (N222) while Group 2 was made up of a historical cohort (uncemented; N254). Clinical and radiological records were reviewed to determine dislocation rates, causes and associative factors of dislocations. Data were analysed using SPSS. Results Following 476 hemiarthroplasties performed during the study period, 12 (2.5%) dislocations were reported (eight in Group 1; four in Group 2). There was no significant difference in dislocation rates (3.6% vs 1.6%) between groups ( p = 0.159). Subgroup analysis of Group 1 demonstrated a significant difference in dislocations with Furlong cemented (6%) as compared with Furlong uncemented (0%) hemiarthroplasties ( p = 0.024). Following dislocation, death rates increased to 8.3% from 1.7% in both groups. Conclusion There is a statistically significant increase in dislocation rate following use of cemented Furlong prosthesis when compared to similar uncemented prosthesis at the same treatment period. However, when compared to traditional uncemented prosthesis, there is no difference in dislocation rates.