Medium-term Outcomes of Cemented Prostheses and Cementless Modular Prostheses in Revision Total Hip Arthroplasty

Abstract

There is an increasing trend towards cementless modular femoral prostheses for revision hip replacement surgery, especially in patients with severe proximal femoral bone defects. However, for minor femoral bone defects, the benefit of cementless modular is not clear. We designed a retrospective cross-sectional study to compare outcomes of the two femoral implant designs. There were no significant differences in terms of visual analog pain scores, Harris hip scores, femoral bone restoration, stem subsidence, leg length correction, or overall complication rate. Three femoral reoperations (11%) occurred in the cemented group, and two (9%) in the cementless modular group. One femoral stem re-revised (4%) in the cemented group due to recurrent deep infection. Five-year survival for femoral reoperation was 88.2% for patients with the cemented implant and 91.3% for cementless group. Both groups had good clinical and radiological outcomes for femoral revision in patients with minor femoral bone defects during medium-term follow-up.

Cemented versus uncemented femoral component total hip arthroplasty in elderly patients with primary osteoporosis: retrospective analysis with 5-year follow-up

“…2,21 The underlying cause of early failure is generally attributed to insufficient initial stability of the interface. 16 Because the initial stability of UN THA depends primarily on fixation between the prosthesis and bone, selection of suitable patients is needed, in combination with the use of an appropriate prosthesis and effective surgical techniques. 6,11 Following changes in prosthesis design and surface coating technology, short-term and medium-term success of UN THA have led to wide acceptance among clinicians.…”

“…Since the development of artificial joints, controversy regarding CE vs. UN femoral components in THA has been an important issue in the field of prosthesis replacement. 16 The principles of CE fixation and low friction associated with metal-polyethylene have been important in the development of modern THA. 3 Mechanical stability of the interface is achieved through bulk filling of bone cement between the prosthesis and bone, as well as by microscopic interlocking.…”

Midterm results of the cylindrical fully porous-coated uncemented femoral stem in revision patients with Paprosky I–IIIA femoral defects

“…4,5,[13][14][15][16][17] In the study conducted by Wang et al, the 5-year survival rates of the cemented and cementless stems were 88.2% and 91.3%, respectively. 18 Bone grafts are utilized frequently in revision hip arthroplasty to compensate for present bone loss. Bone grafts serve two purposes, including mechanical support and osteogenesis.…”

“…4,5,13 –17 In the study conducted by Wang et al, the 5-year survival rates of the cemented and cementless stems were 88.2% and 91.3%, respectively. 18…”

Cementless primary or revision stem in revision hip arthroplasty for aseptic stem loosening with Paprosky type I/II femoral defect?

“…The reasons to exclude a cemented stem as the first-line treatment option at our institution included bone-cement implantation syndrome during implanting a cemented stem 27 and technical challenges and complications during the rerevision procedure of a well-fixed cemented stem, including massive bone loss, cortical perforation, or fracture. 28,29 Cementless femoral stems were considered first in all revision hip arthroplasty procedures, except for patients with severe osteoporosis. Because of the relatively small sample size (N = 13), we excluded the use of cemented stem from our analysis.…”