JOA - 2026-06-01 - Journal Article
A United States Medicare Population-Based Cost-Effectiveness Analysis of Cemented Stem Fixation When Treating Femoral Neck Fractures.
Blythe R, Chen AF, Graves N, De A, Porter KR, Crawford R, Springer BD
Topics
Key Takeaway
Switching entirely to cemented femoral fixation for femoral neck fractures in Medicare patients could save $126.6 million annually and gain 1,356 QALYs over five years, with cost-effectiveness demonstrated in 92% of simulations.
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Summary
This Markov model compared cemented versus cementless femoral fixation for HA and THA in Medicare patients aged 65+ with femoral neck fractures, using AJRR revision, dislocation, and mortality rates stratified by three age cohorts. Complete conversion to cemented fixation yielded $5.0 million in annual cost savings (95% UI: -$0.6 to $8.0M) and 1,356 QALYs gained per simulated cohort, extrapolating to $126.6 million in annual system-wide savings. Cost-effectiveness was confirmed in 92% of probabilistic sensitivity analyses, driven primarily by lower postoperative complication rates with cemented stems.
Key Limitation
The model does not account for bone cement implantation syndrome risk or intraoperative mortality associated with cemented fixation in the highest-risk 85+ cohort, potentially overstating net benefit in that subgroup.
Original Abstract
BACKGROUND
The number of hip fractures in the United States continues to increase each year. Current guidelines recommend cemented femoral fixation when performing hemiarthroplasty (HA) and total hip arthroplasty (THA). Yet, more than half of femoral neck fractures in older patients are treated with cementless femoral fixation in the United States. This study examined the costs and quality-adjusted life years of cemented and cementless femoral fixation for HA and THA procedures at the population level in the United States using data from the American Joint Replacement Registry.
METHODS
A Markov model was created for 11,339 Medicare patients aged 65 to 74, 75 to 84, and 85-plus years in the American Joint Replacement Registry. We simulated the expected impact on costs and health outcomes over five years if all patients received the same femoral fixation method for both HA and THA based on age. Revision, dislocation, and mortality rates, costing data, and health utilities from registry data and published literature were used to populate the model. We simulated outcome uncertainty with probabilistic sensitivity analysis.
RESULTS
By switching entirely to cemented fixation, Medicare can achieve annual cost savings for these patients of $5.0 million (95% uncertainty interval [UI]: -$0.6 to $8.0 million) and 1,356 (95% UI: -618 to 3,362) quality-adjusted life years. Cost-effectiveness was observed in 92% of simulations. Extrapolated over the annual incidence of hip fractures treated with arthroplasty in the US Medicare population, this could equate to $126.6 million (95% UI: -$15.0 to $201.2 million) in annual cost savings.
CONCLUSIONS
Cementless fixation remains the dominant mode of fixation for hip fractures in the United States. This cost-effectiveness study suggests potential cost savings and improved quality of life from switching to cemented femoral fixation for femoral neck fractures for both HA and THA, primarily due to lower postoperative complication rates.