Cemented versus Cementless Total Hip Arthroplasty in Paget's Disease of Bone: A Systematic Review

Abstract

The purpose of this study is to systematically review the clinical evidence for the use of cemented and cementless total hip arthroplasty (THA) in Paget's disease of bone (PDB), and to ascertain whether any difference exists in clinical outcomes between the two implant types. MEDLINE, EMBASE, and the Cochrane Library databases were searched in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The quality of the studies was assessed using the methodological index for nonrandomized studies (MINORS) checklist. The reported clinical outcomes were evaluated using risk ratio (RR) with a p < 0.05 considered as statistically significant. Thirteen clinical studies with 444 primary THAs were included in this review. Cementless THA resulted in lower rates of aseptic loosening and lower rates of revision due to aseptic loosening (p < 0.05), but there was no overall statistically significant increase in the incidence of revision in the cemented THAs (p = 0.21). The postoperative Harris hip score was similar between both the groups. Also, the presence of heterotrophic ossification was similar in both the groups. Functional outcomes and survivorship were equivalent using either cementless or cemented components, with a similar rate of overall revisions. However, cementless components resulted in a decreased incidence of aseptic loosening and revision due to aseptic loosening. The current literature consists of a low level of evidence, level IV, which limits the conclusion of this study.

Clinical and radiological outcomes of total hip arthroplasty in patients affected by Paget’s disease: a combined registry and single-institution retrospective observational study

“…However, bone cement can be challenging in these patients because of bone sclerosis contrasting cement penetration in the trabeculae, and also because of bone remodelling that could weaken the bone-cement interface [1]; for these reasons, the use of uncemented implants has been advocated [1,6]. In general, both cemented and uncemented implant revision and survival rates are similar [6,15]. In a recent review by Hanna et al [6], no difference in revision rates between cemented and uncemented implants was found.…”

“…Challenges related to surgery are due to the presence of bone sclerosis and deformities, the increased risk of periprosthetic fractures and the developing HO [6]. Implant fixation to the bone has been a matter for debate; bone cement has been widely used in the past, although some studies found a higher incidence of radiolucency at the bone-cement interface, and some authors support the use of uncemented implants [1,12,14,15]. At present, only one registry study is available on the topic, reporting about 114 patients operated on for THAs [16], but like in many registry studies, clinical outcomes are missing.…”

Total Hip Replacements in Patients with Rare Pathologic Conditions Affecting Bone

“…Although there is limited literature on comparative studies of cemented versus cementless THA, Hurley at al. 23 performed a systematic review comparing the 2 fixation methods in patients with PBD, which included 13 case series with 444 primary THAs (111 cementless and 333 cemented). The study found that THA with cementless components had a significantly lower risk of aseptic loosening (1.8% [2 of 111] versus 24.6% [82 of 333]; p = 0.0002) and lower rates of revision (9.1% [1 of 11] versus 7.5% [25 of 333]; p = 0.0365) 23 .…”

“…23 performed a systematic review comparing the 2 fixation methods in patients with PBD, which included 13 case series with 444 primary THAs (111 cementless and 333 cemented). The study found that THA with cementless components had a significantly lower risk of aseptic loosening (1.8% [2 of 111] versus 24.6% [82 of 333]; p = 0.0002) and lower rates of revision (9.1% [1 of 11] versus 7.5% [25 of 333]; p = 0.0365) 23 . It has been hypothesized that this is due to the vascularity of pagetoid bone, making it difficult to obtain the dry bone bed required for optimal cement penetration 63 .…”

“…Previous literature on THA in the treatment of PDB is limited to case studies and series looking primarily at short-term outcomes with very limited studies on long-term outcomes [10][11][12][13][14][15][16][17][18][19][20] . Because of the increased perioperative risks and anatomical deformities seen in these individuals, there is a need for altered management and planning at all stages of surgery 10,14,17,[19][20][21][22][23] .…”