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

• Published in: Clinical orthopaedics and related research 2013-11, Vol.471 (11), p.3588-3595
• Main Authors: Wechter, John, Comfort, Thomas K., Tatman, Penny, Mehle, Susan, Gioe, Terence J.
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Hip - instrumentation; Arthroplasty, Replacement, Hip - methods; Bone Cements - therapeutic use; Chi-Square Distribution; Clinical Research; Conservative Orthopedics; Female; Femur - physiopathology; Femur - surgery; Hip; Hip Joint - physiopathology; Hip Joint - surgery; Hip Prosthesis; Humans; Kaplan-Meier Estimate; Male; Medicine; Medicine & Public Health; Minnesota; Orthopedics; Osteolysis - etiology; Osteolysis - prevention & control; Proportional Hazards Models; Prosthesis Design; Prosthesis Failure; Registries; Reoperation; Risk Factors; Sports Medicine; Surgery; Surgical Orthopedics; Time Factors; Treatment Outcome
• ISSN: 0009-921X; 1528-1132
• DOI: 10.1007/s11999-013-3182-5

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