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Randomized Controlled Trial
. 2011 Jan;469(1):209-17.
doi: 10.1007/s11999-010-1459-5. Epub 2010 Jul 13.

What works best, a cemented or cementless primary total hip arthroplasty?: minimum 17-year followup of a randomized controlled trial

Kristoff Corten  1 , Robert B Bourne, Kory D Charron, Keegan Au, Cecil H Rorabeck
Affiliations
Randomized Controlled Trial

What works best, a cemented or cementless primary total hip arthroplasty?: minimum 17-year followup of a randomized controlled trial

Kristoff Corten et al. Clin Orthop Relat Res. 2011 Jan.

Abstract

Background: Total hip arthroplasty (THA) has been associated with high survival rates, but debate remains concerning the best fixation mode of THA.

Questions/purposes: We conducted a randomized controlled trial (RCT) with 250 patients with a mean age of 64 years between October 1987 and January 1992 to compare the results of cementless and cemented fixation.

Patients and methods: Patients were evaluated for revision of either of the components. One hundred twenty-seven patients had died (51%) and 12 (4.8%) were lost to followup. The minimum 17-year followup data (mean, 20 years; range, 17-21 years) for 52 patients of the cementless group and 41 patients of the cemented group were available for evaluation.

Results: Kaplan-Meier survivorship analysis at 20 years revealed lower survival rates of cemented compared with cementless THA. The cementless tapered stem was associated with a survivorship of 99%. Age younger than 65 years and male gender were predictors of revision surgery.

Conclusions: The efficacy of future RCTs can be enhanced by randomizing patients in specific patient cohorts stratified to age and gender in multicenter RCTs. Including only younger patients might improve the efficacy of a future RCT with smaller sample sizes being required. A minimum 10-year followup should be anticipated, but this can be expected to be longer if the difference in level of quality between the compared implants is smaller.

Level of evidence: Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Figures

Fig. 1
Fig. 1
An overview of the followup for patients in the cementless group is shown.
Fig. 2
Fig. 2
An overview of the followup for patients in the cemented group is shown.
Fig. 3
Fig. 3
An age group representation at the beginning of the study and at final followup is shown.
See this image and copyright information in PMC

References

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