Improved Survival of Uncemented versus Cemented Femoral Stems in Patients Aged < 70 Years in a Community Total Joint Registry

Abstract

Background Aseptic loosening of the femoral stem remains a significant reason for revision in total hip arthroplasty (THA). Although stem fixation methods have changed over time, there is relatively little evidence supporting cemented or uncemented stems as more durable constructs. Questions/purposes We examined whether there was a difference in survival to revision between cemented and uncemented THA stems (1) for any reason; (2) for aseptic loosening or loosening related to wear/osteolysis; (3) based on patient age groupings (as a proxy for patient activity level); and (4) based on procedural timeframe groupings between cemented and uncemented stems. Methods A total of 6498 primary cemented and uncemented THAs were registered in our community total joint replacement registry between 1991 and 2011. Analysis was performed to compare age, sex, procedural timeframe, and diagnosis for both groups. Our primary outcome was revision of the stem component for aseptic loosening or loosening secondary to wear/osteolysis. Analyses were done using Wilcoxon rank sum tests, Pearson's chi-square tests, Kaplan Meier methods, and Cox regression. Results After adjusting for age, sex, primary diagnosis, and procedural timeframe as confounders, cemented femoral stem components were 1.63 times as likely as uncemented stems to be revised for any reason (p = 0.02) and 3.76 times as likely as uncemented stems to be revised for aseptic loosening or loosening related to wear/osteolysis (p \ 0.001). When grouped by age, specifically in regard to revisions for aseptic loosening or loosening related to wear/osteolysis, uncemented stems had lower cumulative revision rates in patients aged \ 70 years (p \ 0.001) compared with cemented stems. There was a trend away from cemented fixation in our registry, which shifted from over 80% cemented stem use in 1996 to 3% in 2011.

Bilateral Neck of Femur Fractures in a Bilateral Below-Knee Amputee: A Unique Case

“…Benefits of uncemented implants include less need for revision due to aseptic loosening, but drawbacks are a higher incidence of periprosthetic fracture [12]. There is no difference in infection or dislocation [13].…”

CORR Insights®: High Early Failure Rate After Cementless Hip Replacement in the Octogenarian

“…The inclusion of surgeons throughout the country increased the generalizability of the results, but we know little about how the more recent adoption of cementless techniques in Finland, and its relatively low prevalence, may have contributed to the reported findings. In a community registry where nearly twice as many cementless stems compared to cemented stems were performed, researchers found no difference in cumulative revision rate between the fixation modes for patients older than 70 years [8]. Finally, the study contributed relatively little insight into prosthetic factors, despite the fact that one of the more common cementless devices used (Stryker ABG II 1 [Mahwah, NJ USA]) was identified as having a higher than anticipated revision rate by the Australian Orthopaedic Association [1] and has been the subject of negative reports [6].…”

“…However, it is clear that surgeon preference for fixation of the femoral stem in THA, and the factors that influence that choice, have changed. In one US community practice joint registry [8], use of cemented femoral stems dropped from more than 80% in 1996 to 3% in 2011. While we await data from the nascent American Joint Replacement Registry (AJRR), epidemiologic estimates suggest that 86% of primary THAs in the United States are cementless on both the femoral and acetabular side, less than 1% are fully cemented, and the remainder are hybrid constructs [3].…”

“…Numerous single-institution studies [4,10] have reported excellent midterm results with cementless THA designs in octogenarians, but larger registry studies have either showed no difference [8], or outcomes favoring cemented THAs in older ( ‡ 70 years) patient groups [7]. Mortality associated with fixation method also remains controversial since comorbidities may influence both the fixation selected and mortality itself [5].…”

Evaluation of topographical and chemical modified TiAl6V4 implant surfaces in a weight‐bearing intramedullary femur model in rabbit

“…Both, a lack of bone tissue integration and infections can lead to complications and finally implant failure (Clohisy, Calvert, Tull, McDonald, & Maloney, 2004). For cementless total hip arthroplasty aseptic loosing rates of 2-10% within 10 years were reported in several national arthroplasty registries (Cherian, Jauregui, Banerjee, Pierce, & Mont, 2015;Giardina et al, 2018;Troelsen, Malchau, Sillesen, & Malchau, 2013;Wechter, Comfort, Tatman, Mehle, & Gioe, 2013). The rate of infections of TJR after primary procedures is around 2% in hip and knee arthroplasties, and after revision procedures considerably higher (Al Mohajer & Darouiche, 2014;Corvec, Portillo, Pasticci, Borens, & Trampuz, 2012;Darouiche, 2004;Kurtz et al, 2018).…”