Mitigating surgical risk in patients undergoing hip arthroplasty for fractures of the proximal femur

This Rapid Response Report alerts healthcare organisations to the risk of intra-operative death after the use of bone cement during hip arthroplasty. This carries a baseline risk regardless of whether cement is used, but use of bone cement has been associated with bone cement implantation syndrome (BCIS).

Patients undergoing hip fracture repair usually suffer from several comorbidities which adds to the poorer outcomes.

There remains a range of opinion in the orthopaedics community and in the medical literature surrounding the use of the bone cement. However, the National Reporting and Learning Service (NRLS) is aware of 26 patient deaths and six cases of severe harm where bone cement was used during hip surgery between October 2003 and October 2008. The Medicines and Healthcare products Regulatory Agency (MHRA) has also received reports of deaths and severe harm.

Healthcare organisations should:

• Report to the NRLS and MHRA every peri-operative harm or patient death for total hip replacement and hemiarthroplasty. Reports should include use of cemented or uncemented prosthesis.
• Share the results of local investigations with the NRLS.
• Review local guidelines and audit current activity.
• Submit data to the National Hip Fracture Database.
• Reduce risks through patient assessment and revised anaesthetic and surgical techniques.