Cementless Femoral Prostheses Cost More to Implant than Cemented Femoral Prostheses

Abstract

Prosthetic cost contributes greatly to the overall expense of THA. A key question, therefore, in the selection of implant technique is whether any price difference exists between a cementless and a cemented femoral prosthesis. We evaluated the price difference between the most commonly used cemented and cementless femoral stems at three high-volume academic medical centers. Each hospital's costs for prostheses from the manufacturers were recorded. The average cost of implanting a cementless femoral prosthesis was $296 more than the average cost of implanting a cemented femoral stem, even with the additional expense of two batches of bone cement and the accessories commonly used to achieve a third-generation cementing technique. The price difference was less variable if the cost of the prostheses from only the primary implant supplier for each institution was considered. As the number of THAs performed per year continues to escalate, implantation of a cemented femoral component remains an attractive method of fixation from an economic standpoint.

The Otto Aufranc Award: Enhanced Biocompatibility of Stainless Steel Implants by Titanium Coating and Microarc Oxidation

“…However, Ti alloy is difficult to work with during manufacturing, and it is expensive since the demand for Ti has increased due to its use in various industrial fields. Thus, in developing countries especially, cemented stems are more commonly used than cementless stems [23].…”

Still no single gold standard for using cementless femoral stems routinely in total hip arthroplasty

“…The 8th Annual National Joint Registry Report found that the cost of a primary cemented femoral component plus the associated cement and accessories is £820 per THA, whereas the cost of a primary cementless femoral component was £915 per THA [46], [47]. Similar data from the United States agree that cementless femoral prostheses are consistently more expensive than cemented femoral prostheses even when including the cost of cement plus accessories [14]. The indirect primary costs such as quality of life and patient satisfaction should be combined with the direct primary THA costs to fully determine value.…”

“…Bone cement implantation syndrome is characterized by hypoxia, hypotension, or both and/or the unexpected loss of consciousness and is most commonly associated with cemented THA [13]. Cemented femoral stems also have certain benefits; they have been shown to minimize the risk of early complications, as well as having excellent long-term survivorship, and are cost-effective implants [14], [15].…”

Acrylic bone cement in total joint arthroplasty: A review

“…The cemented femoral components provide immediate postoperative stability with better integration between bone, cement, and prosthesis, leading to earlier pain relief and weight bearing . Also, implanting cemented prostheses costs less than cementless prostheses by an average of $300 . Despite these results, there is an increasing trend in cementless implants in the last decade …”