Current femoral stem fixation in hip arthroplasty for hip fractures after the revised national guidelines in Japan: a questionnaire survey in a super-aging prefectural area

Background: The Japanese guidelines for the management of hip fractures were most recently revised in 2021 to recommend the use of cemented stems in cases of bone fragility. However, the selection of cementless or cemented stem fixations remains controversial. This study aimed to examine the current stem selection strategy in bipolar hemiarthroplasty, concerns about using cemented stems, and factors affecting the ability to instruct cemented stems. Methods: This study included 94 orthopedic surgeons from 27 facilities who answered a web-based questionnaire survey of 15 questions in the super-aging prefectural area in Japan from January to February 2022. Multiple logistic regression analysis was used to identify the factors associated with the ability to instruct the cemented stem. The cutoff value for the number of cemented stem usage experiences that can be used to instruct cemented stems was determined using the receiver operating characteristic (ROC) curve. Results: A total of 97.8% of doctors answered that the cementless stem was the current first choice, and 83.0% of doctors had only 0–10 cases of the cemented stem. Meanwhile, only 14.9% of doctors are expected to increase the use of cemented stems in the future. The cement technique was the greatest concern regarding the use of cement stems (60.6%). On multivariate analysis, the number of surgeries of the cemented stem was the factor most affecting the ability to instruct the cemented stem (odds ratio: 8.42, p=0.001). In the ROC curve analysis for the capability of instructing cemented stems and the number of surgeries using cemented stems, the best cutoff value was 1–10 cases (sensitivity, 94.4%; specificity, 58.6%), with an area under the curve of 0.8448 (95% confidence interval: 0.7754–0.9142). When the cut-off value was 11–50 cases, the specificity was higher (sensitivity, 41.7%; specificity, 98.3%). Conclusions: A few doctors still select cemented stems as the first choice. The number of surgeries on the cemented stem was the factor most affecting the ability to instruct the cemented stem, and more than 11 cases are desirable.