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Cemented fixation provides better results than cementless fixation for total hip arthroplasty in patients 80 years or older, study reveals

Friday, October 03 2008 | Comments

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What's This? Cementation of the femoral stem provides better long-term results than cementless fixation in patients aged >=80 years who have a total hip replacement, according to a recent study.

To determine the factors that affect survivorship rates in total hip replacement in patients >=80 years old, researchers evaluated data from 6,540 patients (6,989 hips) in the Finnish Arthroplasty Registry who underwent the procedure between 1980 and 2004.

In 5,047 (82%) of the 6,175 hips included in the analysis, both components of the replacement were fixed with cement. Hybrid fixation (either the femoral or acetabular component was fixed with cement) was used in 729 hips (12%) while the remaining 399 hips (6%) were inserted with cementless fixation. Of the hips with hybrid fixation, 91% had the femoral component fixed with cement and 9% had the acetabular component fixed with cement.
The study endpoint was revision for any reason and was measured using Kaplan-Meier survivorship analysis. The first revision was defined as any operation on the hip that involved removal, exchange, or reimplantation of 1 or both of the prosthetic components.

Of the total 6,989 primary total hip replacements, 195 were revised. For the 183 hips that had complete data on the revision, the most common reasons for revisions were aseptic loosening (84 hips; 46%), recurrent dislocation (36 hips; 20%), periprosthetic fracture (24 hips; 13%), and infection (23 hips; 13%).

Results showed that the overall Kaplan-Meier survivorship of the hip prosthesis was 97% (95% confidence interval [CI], 96%-97%) at 5 years and 94% (95% CI, 93%-95%) at 10 years. Survivorship of the total hip replacement was significantly associated with female sex (P<.0005), hybrid fixation compared with cementless fixation (P<.05) and an earlier time period during which the arthroplasty was performed (1980 to 1989 compared with 1995 to 1999; P<.05).

"Because of a lack of national guidelines and because of aggressive marketing, Finland has traditionally been an experimental ground for implant companies and for new innovations and prosthetic designs," the authors noted. "At present, this shows up in the extensive use of 'hybrid' fixation and the use of multiple stem-cup combinations. Most of these combinations are so rare that the important task of performing postmarketing registry surveillance is not possible because the analyses currently lack statistical power. With further follow-up, some trends may emerge." (Ogino D, et al. J Bone Joint Surg AM 2008;90:1884-1890.)

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