Long-term follow-up outcomes for patients undergoing primary total hip arthroplasty with uncemented versus cemented femoral components: a retrospective observational study with a 5-year minimum follow-up

Abstract

BackgroundThis retrospective analysis compared the long-term outcomes for patients with a femoral neck fracture (AO/OTA type 31B) treated with a primary unilateral total hip arthroplasty with uncemented or cemented femoral components (UTHA or CTHA, respectively).MethodsWe conducted a retrospective cohort study using the South China Hip Arthroplasty Database. We identified 422 patients with femoral neck fracture (AO/OTA type 31B) who were previously treated with primary unilateral UTHA or CTHA between 2007 and 2015, with follow-up until 2019. Follow-up occurred 1, 3, 6 and 12 months postoperatively and yearly thereafter. The primary outcome was the Harris hip score (HHS). The secondary outcome was the orthopaedic complication rate.ResultsIn total, 324 patients (UTHA n = 160, mean age 68.61 ± 7.49 years; CTHA n = 164, mean age 68.75 ± 7.04 years) were evaluated for study eligibility. The median follow-up was 73.3 months (range, 11.6–89.2 months). At the final follow-up, HHS was 74.09 ± 6.23 vs 79.01 ± 10.21 (UTHA vs CTHA, p = 0.012). Significant differences were detected in the incidence of prosthetic revision, loosening, and periprosthetic fracture between the UTHA and CTHA groups (7.5% for UTHA vs 1.8% for CTHA, p = 0.015; 17.5% for UTHA vs 8.5% for CTHA, p = 0.016; 11.9% for UTHA vs 4.9% for CTHA, p = 0.021, respectively).ConclusionIn this setting, CTHA demonstrated superiority to UTHA by improving functional outcomes and decreasing complication rates.

Cemented versus uncemented total hip arthroplasty for failed proximal femoral nail anti-rotation fixation in patients with intertrochanteric femur fractures: 5-year results of a retrospective observational study

“…Additionally, no literature has provided guiding principles to reduce or avert mechanical complications [27]. Consistent with previous randomised studies [28], we failed to observe conspicuous differences in the HHS at the end of the 3-year followup. Although this lack of differences could be attributed to the relatively short follow-up, not everyone was convinced by this explanation.…”

“…Additionally, our study sheds light on the risk for re-revision surgery for patients with failed PFNA treated with UTHA. Although it has been previously recognised that this cohort has a higher 5-year revision rate than those undergoing CTHA, the true risk to a patient with failed PFNA treated with UTHA appears much higher than previously reported [28]. The higher rate of re-revision could be associated with dissimilarities in implant materials.…”

“…Nevertheless, the majority of population reports that focus on this subject are based on 10-year follow-up data. Few prior studies have quantified the risk for rerevision in this setting [28]. Additionally, our study sheds light on the risk for re-revision surgery for patients with failed PFNA treated with UTHA.…”

“…Nevertheless, the quantitative comparison is problematic for interpretation since a majority of prior reports included a mixed population of proximal femoral fractures and multi-ethnic, younger patients, and stress shielding of the proximal femur is especially age-dependent [3]. Previous literature has demonstrated that UTHA has a higher rate of orthopaedic complications than CTHA [21,28]. Additionally, recent evidence favours UTHA for proximal femur fractures despite the high rate of orthopaedic complications [25].…”

Cemented versus uncemented total hip replacement for femoral neck fractures in elderly patients: a retrospective, multicentre study with a mean 5-year follow-up

“…A direct anterior approach was used for all patients. The technical details and rehabilitation instructions have been described in our previous report [16]. The patient inclusion criteria were age 60 years or older and FNFs (AO/OTA type 31B/C) confirmed using conventional radiographs or computed tomography (CT).…”