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. 2020 Feb;91(1):33-41.
doi: 10.1080/17453674.2019.1682851. Epub 2019 Oct 30.

Fixation, sex, and age: highest risk of revision for uncemented stems in elderly women - data from 66,995 primary total hip arthroplasties in the Norwegian Arthroplasty Register

Håvard Dale  1   2 , Sjur Børsheim  3 , Torbjørn Berge Kristensen  1 , Anne Marie Fenstad  1 , Jan-Erik Gjertsen  1   2 , Geir Hallan  1   2 , Stein Atle Lie  1   4 , Ove Furnes  1   2
Affiliations

Fixation, sex, and age: highest risk of revision for uncemented stems in elderly women - data from 66,995 primary total hip arthroplasties in the Norwegian Arthroplasty Register

Håvard Dale et al. Acta Orthop. 2020 Feb.

Abstract

Background and purpose - There is no consensus on best method of fixation in hip arthroplasty. We investigated different modes of fixation in primary total hip arthroplasty (THA) and the influence of age and sex, to assess need for a differentiated approach.Patients and methods - The study was based on data from the Norwegian Arthroplasty Register in the period 2005-2017. Included were all-cemented, all-uncemented, reverse hybrid (uncemented stem and cemented cup), and hybrid (cemented stem and uncemented cup) THA designs that were commonly used, contemporary and well documented, using different causes of revision as endpoints.Results - From the included 66,995 primary THAs, 2,242 (3.3%) were revised. Compared with all-cemented THAs, all-uncemented had a higher risk of revision due to any cause (RR 1.4; CI 1.2-1.6), mainly due to an increased risk of periprosthetic fracture (RR 5.2; CI 3.2-8.5) and dislocation (RR 2.2; CI 1.5-3.0). Women had considerably higher risk of revision due to periprosthetic fracture after all-uncemented THA (RR 12; CI 6-25), compared with cemented. All-uncemented THAs in women of age 55-75 years (RR 1.3; CI 1.0-1.7) and over 75 years of age (RR 1.8; CI 1.2-2.7), and reverse hybrid THAs in women over the age of 75 (RR 1.5; CI 1.1-1.9) had higher risk of revision compared with cemented. Hybrid THAs (RR 1.0; CI 0.9-1.2) and reverse hybrid THAs (RR 1.0; CI 0.7-1.3) had similar risk of revision due to any cause as cemented THAs.Interpretation - Uncemented stems (all-uncemented and reverse hybrid THAs) had increased risk of revision in women over 55 years of age, mainly due to periprosthetic fracture and dislocation, and should probably not be used in THA in these patients.

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Figures

Figure 1.
Figure 1.
Flowchart of inclusion and exclusion of THAs. a There may be more than 1 missing variable per THA.
Figure 2.
Figure 2.
Adjusted implant survival curves with any revision as endpoint, for the 4 types of THA fixation in all THAs, THA in males, and THA in females, adjusted for age, sex (in all THAs only), ASA class, indication for primary THA, surgical approach, articulation, head size of the prosthesis, and year of primary surgery
Figure 3.
Figure 3.
Graphical representation of the relationship between age at primary THA and the log relative risk (RR) for revision due to all causes for uncemented and reverse hybrid compared with cemented THAs, for women and men with 95% confidence intervals. The horizontal green line shows the reference hazard rate ratio (RR = 1) of cemented THAs. The vertical lines indicate 55 and 75 years of age. We adjusted for ASA class, indication for primary THA, surgical approach, articulation, head size of the prosthesis, and year of primary surgery in the analyses. Hybrid THAs are omitted due to low numbers.
Figure 4.
Figure 4.
Adjusted implant survival curves for different causes of revision for 3 types of THA fixation in women and men, adjusted for age, ASA class, indication for primary THA, surgical approach, articulation, head size of the prosthesis, and year of primary surgery. Hybrid THAs are omitted due to low numbers.
Figure 5.
Figure 5.
Graphical representation of the relationship between year postoperatively and the log relative risk (RR) for revision due to all causes for uncemented, reverse hybrid, and hybrid THAs, compared with cemented THAs, with 95% confidence intervals. The horizontal green line shows the reference hazard rate ratio (RR = 1) of cemented THAs. The vertical lines indicate 1 and 3 years postoperatively. We adjusted for sex, age, ASA class, indication for primary THA, surgical approach, articulation, head size of the prosthesis, and year of primary surgery in the analyses
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