Cemented versus uncemented fixation in total hip replacement: a systematic review and meta-analysis of randomized controlled trials

Abdulkarim, Ali; Ellanti, Prasad; Mondaini, Nicola; Fahey, Tom; O’Byrne, J.

doi:10.4081/or.2013.e8

Cited by 112 publications

(104 citation statements)

References 57 publications

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“…This is consistent with the stability of pain scores with time after hip resurfacing [13,28,30]. This is in contrast with studies of pain scores after cemented vs cementless fixations in conventional THAs where the presence of cement can contribute to better pain relief [1].…”

Section: Discussionsupporting

confidence: 82%

Are There Long-term Benefits to Cementing the Metaphyseal Stem in Hip Resurfacing?

Amstutz

Duff

Bhaurla

2015

Clin Orthop Relat Res

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Background Cementing the metaphyseal stem during hip resurfacing surgery improves the initial fixation of the femoral component. However, there may be long-term detrimental effects such as stress shielding or an increased risk of thermal necrosis associated with this technique. Questions/purposes We compared (1) long-term survivorship free from radiographic femoral failure, (2) validated pain scores, and (3) radiographic evidence of component fixation between hips resurfaced with a cemented metaphyseal stem and hips resurfaced with the metaphyseal stem left uncemented. Methods We retrospectively selected all the patients who had undergone bilateral hip resurfacing with an uncemented metaphyseal stem on one side, a cemented metaphyseal stem on the other side, and had both surgeries performed between July 1998 and February 2005. Fortythree patients matched these inclusion criteria. During that period, the indications for cementing the stem evolved in the practice of the senior author (HCA), passing through four phases; initially, only hips with large femoral defects had a cemented stem, then all stems were cemented, then all stems were left uncemented. Finally, stems were cemented for patients receiving small femoral components (\48 mm) or having large femoral defects (or both). Of the 43 cemented stems, two, 13, 0, and 28 came from each of those four periods. All 43 patients had complete followup at a minimum of 9 years (mean, 143 ± 21 months for the uncemented stems; and 135 ± 22 months for the cemented stems; p = 0.088). Survivorship analyses were performed with Kaplan-Meier and Cox proportional hazards ratios using radiographic failure of the femoral component as the endpoint. Pain was assessed with University of California Los Angeles (UCLA) pain scores, and radiographic femoral failure was defined as complete radiolucency around the metaphyseal stem or gross migration of the femoral component. Results There were four failures of the femoral component in the press-fit stem group while the cemented stem group had no femoral failures (p = 0.0471). With the numbers available, we found no differences between the two groups regarding pain relief or radiographic appearance other than in patients whose components developed loosening. Conclusions Cementing the metaphyseal stem improves long-term implant survival and does not alter long-term pain relief or the radiographic appearance of the proximal femur as had been a concern based on the results of finite element studies. We believe that patients with small component sizes and large femoral head defects have more to gain from the use of this technique which adds surface area for fixation, and there is no clinical downside to cementing the stem in patients with large component sizes.

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Section: Discussionsupporting

confidence: 82%

Are There Long-term Benefits to Cementing the Metaphyseal Stem in Hip Resurfacing?

Amstutz

Duff

Bhaurla

2015

Clin Orthop Relat Res

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“…any reason was more likely in patients \ 70 years old in whom the index arthroplasty was performed using a cementless technique (HR, 1 Conclusions We found no differences in the risk of second revision in the overall cohort between cementless and cemented techniques; however, we observed an increased risk for rerevision THA performed on patients \ 70 years whose index THAs were performed using cementless components when looking at all causes for revision, even after adjusting for the most likely confounding factors. Our data suggest that increased use of cementless fixation in primary THA may lead to inferior survivorship of first revision THA.…”

mentioning

confidence: 72%

“…Changes in femoral fixation technique, from cemented to cementless, can lead to changes in reoperation patterns, including the indications for and durability of subsequent revisions, as well as an effect on femoral bone defects at the time of revision, which might influence the risk profile of those revisions [1,12,17]. However, to our knowledge, the degree to which any of this might be the case has not been evaluated.…”

Section: Introductionmentioning

confidence: 99%

Do Rerevision Rates Differ After First-time Revision of Primary THA With a Cemented and Cementless Femoral Component?

Gromov

Pedersen

Overgaard

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Worldwide use of cementless fixation for total hip arthroplasty (THA) is on the rise despite some evidence from the world's registries suggesting inferior survivorship compared with cemented techniques. The patterns of bone loss associated with failed cementless and cemented THAs may prejudice the results of future revision procedures; however, this has not been documented. Questions/purposes The purpose of this study was to compare (1) the risk for rerevision of first revision THA; (2) the patterns of femoral bone loss at the time of first revision of primary THA; (3) the reasons for first revision of primary THA; and (4) the time to first revision of primary THA between primary cementless and cemented femoral components. Methods Primary THAs with cemented (n = 1791) and uncemented (n = 805) femoral components that subsequently sustained first revision of the femoral component were identified from the Danish Hip Arthroplasty Registry (DHR). As of 2012, 120,988 primary THAs and 19,282 revisions were registered in the DHR with completeness of 97% and 90% for primary and revision THA, respectively. Median followup for revisions of primary THA with cemented and cementless femoral component was 4 years (range, 0-17 years) and 2 years (range, 0-16 years), respectively. Survival of first revision THA, with second revision of the femur as outcome, was evaluated using hazard ratios (HRs) with 95% confidence interval (CI) adjusting for potential confounding. All patient-and surgery-related data are collected from Danish medical databases. Recording of bone defects in the DHR is based on surgeons' intraoperative findings. Results With the numbers studied, we found no differences in the risk of second revision between the overall cohort between cementless and cemented techniques (HR, 1.32; 95% CI, 0.97-1.80; p = 0.076); however, a second revision for Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. Conclusions We found no differences in the risk of second revision in the overall cohort between cementless and cemented techniques; however, we observed an increased risk for rerevision THA performed on patients \ 70 years whose index THAs were performed using cementless components when looking at all causes for revision, even after adjusting for the most likely confounding factors. Our data suggest that increased use of cemen...

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“…According to their report, no significant difference was found between cemented and uncemented THRs in terms of implant survival as measured by the revision rate. However, they concluded that further research, with improved methodology and longer follow up are needed to better define specific subgroups of patients in whom the relative benefits of cemented and uncemented implant fixation can be clearly demonstrated (18). Until then, the Dorr typing system still maintains its importance in the classification of femoral morphology and deciding whether cemented or uncemented stems should be applied.…”

Section: Discussionmentioning

confidence: 99%

Inter and Intra-Observer Reliability of Dorr Classification in Proximal Femur Morphology

et al. 2018

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Background: Proximal femur morphology determines the choice of cemented or uncemented Total Hip Arthroplasty (THR), and Dorr classification is widely used to type this characteristic. As a result, a considerable reliability for such typing system is expected. Objectives: The current study aimed at assessing inter and intra-observer reliability of Dorr classification in proximal femur morphology. Methods: A total of 50 standard hip radiographs from patients with trauma or THR candidates were evaluated by 6 observers, including 2 senior orthopedic residents, 2 orthopedic surgeons, and 2 hip fellowship-trained orthopedic surgeons, using the Dorr classification system. Subsequently, radiographs were re-numbered and re-evaluated, 6 weeks after the first review. Cohen's Kappa statistic was used for statistical analysis of inter and intra-observer reliability. Results: The mean intra-observer and inter-observer kappa value for the residents was 0.560 and 0.592, respectively. The mean intra-observer and inter-observer kappa value for the orthopedists was 0.566 and 0.540, respectively. The mean intra-observer and inter-observer kappa value for the hip fellowships was 0.477 and 0.490, respectively. Conclusions: A minimum to moderate inter and intra-observer reliability of Dorr classification system was seen between the observers of the current study. These results suggest that the classification of the femur morphology is more challenging than previously described and characterization of a single Dorr type, especially in case of uncertainty between type B and C of Dorr might need reconsideration, in order to prevent its adverse effect on the patients' outcome.

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Cemented versus uncemented fixation in total hip replacement: a systematic review and meta-analysis of randomized controlled trials

Cited by 112 publications

References 57 publications

Are There Long-term Benefits to Cementing the Metaphyseal Stem in Hip Resurfacing?

Are There Long-term Benefits to Cementing the Metaphyseal Stem in Hip Resurfacing?

Do Rerevision Rates Differ After First-time Revision of Primary THA With a Cemented and Cementless Femoral Component?

Inter and Intra-Observer Reliability of Dorr Classification in Proximal Femur Morphology

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