Cemented THA associated with increased complications, aseptic revision vs. cementless THA
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Key takeaways:
- Cemented THA was associated with increased complications compared with cementless THA.
- Patients who underwent cemented fixation had higher rates of infection, aseptic revision and aseptic loosening.
According to published results, cemented total hip arthroplasty was associated with increased rates of infection, aseptic loosening and aseptic revision compared with cementless fixation for patients with osteoarthritis.
Researchers performed a 1:1 propensity-matched cohort analysis of 6,283 patients who underwent cementless THA and 6,283 patients who underwent cemented THA for primary OA between April 1, 2016, and Dec. 31, 2021.
According to the study, researchers assessed outcomes at 90 days, 1 year and 2 years postoperatively. Outcomes included periprosthetic joint infection, aseptic revision, surgical site infection, pulmonary embolism, venous thromboembolism (VTE), wound complications, dislocation, periprosthetic fracture and aseptic loosening.
At 90-day follow-up, patients who underwent cemented THA had higher rates of infection (4.5% vs. 0.8%; OR = 5.9), aseptic revision (2.9% vs. 2%; OR = 1.47), VTE (1.8% vs. 1.3%; OR = 1.40) and aseptic loosening (1.5% vs. 0.7%; OR = 2.31). Researchers also found patients who underwent cemented THA had higher rates of infection, aseptic loosening and aseptic revision at both 1-year and 2-year follow-ups.
“This finding supports the current use of cementless fixation, but the ultimate decision regarding fixation type should be based on the proper optimization of the patients’ comorbidities and bone quality,” the researchers wrote in the study.
Perspective
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This paper reports on patients older than 65 years undergoing total hip arthroplasty with either cemented or cementless femoral fixation. The study reports a higher complication and revision rate for patients undergoing cemented femoral fixation, which is in contradiction to previous published literature. Multiple previous papers, including randomized trials and large database studies, have described the opposite with an increase in periprosthetic fracture with cementless fixation, particularly in patients older than 65 years. The most recent American Joint Replacement Registry also reported a higher periprosthetic fracture rate in patients undergoing cementless fixation but did report a higher revision rate in male patients undergoing cemented fixation. The differences in results between this and other studies is likely related to patient selection, and the strength of this paper is the propensity match that allows for equal comparison between groups.
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