Monoblock hemiarthroplasties for femoral neck fractures – A part of orthopaedic history? Analysis of national registration of hemiarthroplasties 2005–2009 Cecilia Rogmark a,b, *, Olof Leonardsson a , Go ¨ ran Garellick b , Johan Ka ¨ rrholm b,c a Department of Orthopaedic Surgery, Skane University Hospital, Malmo ¨, Sweden b Swedish Hip Arthroplasty Register, Registercentrum VGR, Gothenburg, Sweden c Department of Orthopaedic Surgery, Sahlgrenska University Hospital, Mo ¨lndal, Sweden Hemiarthroplasty is regarded as treatment of choice for displaced femoral neck fractures in elderly individuals but the optimal design of the implant is still a matter of debate, and substantial differences, in implants used, between countries are seen. 1 Even though the inferior clinical results of the uncemented, monoblock Austin-Moore 1 implant 2 are well known from the literature, 3–6 the British National Hip Fracture Database report the use of ‘‘uncemented, uncoated unipolar hemiarthroplasties’’ in 19.2% of the patients in 2010, 7 but implant specific data are not collected. Assumingly, several of these can be Austin-Moore 1 implants as another survey pointed out the common use of monoblock prostheses in UK. 8 As national registration of hemi- arthroplasties is rare, the exact proportion of different designs within a country is often unknown. Another old monoblock implant design, the Thompson 1 prostheses, 9 might gain better clinical results, as shown in the Annual Reports from the Australian National Joint Replacement Register, attributable to the common use of cement when inserting this design. 10 The aim of this study is to compare uncemented monoblock implants, cemented monoblock implants and modern modular implants regarding causes and risk of re-operation, based on national registration in the SHAR during 2005–2009. Materials and methods The SHAR started in 1979. Since 1 January 2005, hemiarthro- plasties are registered as a part of the SHAR. The Register has a 96% completeness of all hemiarthroplasties performed in Sweden. Data are collected by a contact secretary at each unit after surgery and reported to the SHAR through the internet. In concordance with Swedish law, all patients receive information and are free to renounce their participation in the registration at any point. All records in the SHAR are linked to the patients by the individual and unique 10-digit identity number given to all Swedish citizens at birth. The hemiarthroplasty registration includes hemiarthroplas- ties regardless of diagnosis. Primary procedures for femoral neck fractures and salvage procedures after internal fixation are most common. Surgical details (i.e., surgical approach, type of implant and Injury, Int. J. Care Injured 43 (2012) 946–949 A R T I C L E I N F O Article history: Available online xxx Keywords: Hip fractures Arthroplasty Complications Re-operations National register A B S T R A C T This study from the Swedish Hip Arthroplasty Register (SHAR) compares cemented (Thompson 1 , Exeter Trauma Stem (ETS) 1 ) and uncemented (Austin-Moore 1 ) monoblock hemiarthroplasties (n = 1116 and 616, respectively) with modular ones (n = 18,659). Austin-Moore 1 prostheses lead to more re-operations (6.7%) compared to modular implants (3.5%) and Thompson 1 /ETS 1 (2.4%). A Cox regression analysis, adjusting for other risk factors, shows twice the risk of re-operation for Austin-Moore 1 implants (CI 1.5–2.8), in particular, due to periprosthetic fracture (5.4; CI 3.2–9.1) and dislocation (1.9; CI 1.3–3.0). The Thompson 1 /ETS 1 implants do not influence the overall risk of re- operation (0.7; CI 0.5–1.2) compared to modular implants and decrease the risk of re-operation due to infection (0.2;CI 0.04–0.7). An increased risk of re-operation is also seen in men, age groups 75–85 years and <75 years and after secondary fracture surgery. Both Swedish and Australian orthopaedic surgeons have decreased their use of Austin-Moore 1 implants after reports from their national arthroplasty registers identifying inferior outcome for this implant. Due to the increased risk of re-operations, it should not be used in modern orthopaedic care. Cemented Thompson 1 or ETS 1 implants could still be suitable for the oldest, low-activity patients. To finally decide if there is a place for them, patient-reported outcome must be analysed as well. ß 2011 Elsevier Ltd. All rights reserved. * Corresponding author at: Department of Orthopaedic Surgery, Skane University Hospital, SE-205 02 Malmo ¨, Sweden. Tel.: +46 40336123; fax: +46 40337011. E-mail address: cecilia.rogmark@skane.se (C. Rogmark). Contents lists available at SciVerse ScienceDirect Injury jo ur n al ho m epag e: ww w.els evier .c om /lo cat e/inju r y 0020–1383/$ – see front matter ß 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.injury.2011.11.022