Revision following cemented and uncemented primary total hip replacement

Abstract

We have reviewed the rate of revision of fully cemented, hybrid and uncemented primary total hip replacements (THRs) registered in the New Zealand Joint Registry between 1999 and December 2006 to determine whether there was any statistically significant difference in the early survival and reason for revision in these different types of fixation. The percentage rate of revision was calculated per 100 component years and compared with the reason for revision, the type of fixation and the age of the patients. Of the 42 665 primary THRs registered, 920 (2.16%) underwent revision requiring change of at least one component. Fully-cemented THRs had a lower rate of revision when considering all causes for failure (p < 0.001), but below the age of 65 years uncemented THRs had a lower rate (p < 0.01). The rate of revision of the acetabular component for aseptic loosening was less in the uncemented and hybrid groups compared with that in the fully cemented group (p < 0.001), and the rate of revision of cemented and uncemented femoral components was similar, except in patients over 75 years of age in whom revision of cemented femoral components was significantly less frequent (p < 0.02). Revision for infection was more common in patients aged below 65 years and in cemented and hybrid THRs compared with cementless THRs (p < 0.001). Dislocation was the most common cause of revision for all types of fixation and was more frequent in both uncemented acetabular groups (p < 0.001). The experience of the surgeon did not affect the findings. Although cemented THR had the lowest rate of revision for all causes in the short term (90 days), uncemented THR had the lowest rate of aseptic loosening in patients under 65 years of age and had rates comparable with international rates of aseptic loosening in those over 65 years.

Does a Titanium-coated Polyethylene Press-fit Cup Give Reliable Midterm Results?

“…The use of uncemented acetabular components in THA has gained worldwide acceptance with low revision frequencies and high scores in patient-reported outcome studies [1,2,5,19]. Joint registries show that the most common of these components are modular [5,18], allowing the surgeon to change the articulating surfaces to best suit reconstructive demands.…”

“…Joint registries show that the most common of these components are modular [5,18], allowing the surgeon to change the articulating surfaces to best suit reconstructive demands. Modular cups have the advantage of giving the surgeon the option of using a lipped liner to help avoid postoperative dislocation, which is the most common cause for early revision [5], if the cup position is less than ideal. Compared with modular uncemented cups, the use of monoblock, uncemented cups has been less appealing to surgeons because of the uncertainty of adequate seating and positioning of the implant.…”

Clinical Faceoff: Where Are We Going With Femoral Stem Fixation in THA?

“…There is a worldwide trend suggesting an increased use of cementless femoral fixation. Recent registry data [4] report revision for aseptic loosening of cementless femoral components is equal to that of cemented fixation. The main headline of the 2015 National Joint Registry of for England, Wales, Northern Ireland, and the Isle of Man [8] is ''The debate regarding fixation as an isolated observation seems to become less of an issue in that it is the combination of the fixation, articulation and patient characteristics which influence the revision outcome'' [8].…”

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

“…There have been relatively few registry studies that have examined stem revision rates of cemented and uncemented femoral stems resulting from aseptic loosening or loosening related to wear/osteolysis [10,15,17,22], and these do not necessarily reflect the changing practice patterns of North American community orthopaedists over time. We therefore compared the survival of cemented versus uncemented femoral components in a community-based total joint registry.…”