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Comparative Study
. 2024 Dec 12;145(1):15.
doi: 10.1007/s00402-024-05709-4.

Perioperative and short-term outcomes of cemented versus cementless total hip arthroplasty: a retrospective propensity-matched analysis

Muhammad A Haider  1 , Conor Garry  1 , Vinaya Rajahraman  1 , Isabelle Chau  1 , Ran Schwarzkopf  1 , Roy I Davidovitch  1 , William Macaulay  2
Affiliations
Comparative Study

Perioperative and short-term outcomes of cemented versus cementless total hip arthroplasty: a retrospective propensity-matched analysis

Muhammad A Haider et al. Arch Orthop Trauma Surg. .

Abstract

Background: Cement fixation for total hip arthroplasty (THA) remains a controversial topic. While cemented stems are associated with lower risk of periprosthetic fractures (PPF), cementless stems may offer superior biological fixation. This study analyzed peri-operative and short-term outcomes of cemented vs. cementless stem fixation in THA.

Methods: A retrospective review was conducted on 15,012 patients who underwent primary elective THA at an academic medical center from 2011 to 2021. Of these patients, 429 were cemented. Patients were stratified into 3 age cohorts (25-69, 70-79 and ≥ 80 years). Cemented stem patients were 1:1 propensity-score matched to cementless stem patients for baseline characteristics. Perioperative and short-term outcomes were compared.

Results: The mean operative time for cemented cases was significantly longer across all age cohorts (25-69, P = 0.005; 70-79, P < 0.001; ≥80, P < 0.001). In the 70-79 and ≥ 80 cohorts, cemented patients demonstrated a significantly shorter length of stay (LOS) compared to cementless patients (2.2 vs. 2.6 days, P = 0.017; 3.0 vs. 3.4, P = 0.041, respectively). In the 70-79 and ≥ 80 cohorts, cemented patients were significantly more likely to be discharged home when compared to cementless patients (88.2 vs. 80.5%, P = 0.031; 64.0 vs. 54.2%, P = 0.046, respectively). Across age cohorts, there were no differences in all-cause revision rates (Cohort 1: 5.4% vs. 1.1%, P = 0.108; Cohort 2: 3.0% vs. 1.8%, P = 0.362; Cohort 3: 1.8% vs. 1.2%, P = 0.714). The ≥ 80 cohort demonstrated increased rates of PPF in the cementless cohort compared to cemented (1.2 vs. 0%, P = 0.082, respectively), but it did not reach significance.

Conclusion: Patient age has a substantial impact on perioperative outcomes following cemented versus cementless stem THA. Patients > 70 with a cemented femoral stem had improved perioperative outcomes such as shorter LOS, increased discharge to home and reduced rates of PPF compared to their cementless stem counterparts. Patient age should be considered prior to selecting a stem fixation strategy.

Level of evidence: III, Therapeutic Study.

Keywords: Cemented; Cementless; Discharge disposition; Length of stay; Peri-prosthetic fractures; Total hip arthroplasty.

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Conflict of interest statement

Declarations. Ethical approval: The present study was conducted upon receiving approval from the institutional review board (IRB). Competing interests: Mr. Haider has no relevant financial or non-financial interests to disclose. Consent to participate: Informed consent was obtained from all individual participants included in the study. Consent to publish: Consent to publish was obtained from all individual participants included in the study. Competing Interests: Dr. Garry has no relevant financial or non-financial interests to disclose. Ms. Rajahraman has no relevant financial or non-financial interests to disclose. Ms. Chau has no relevant financial or non-financial interests to disclose. Dr. Schwarzkopf reports grants from Smith&Nephew, grants from Intelijoint, stocks from Gauss Surgical, grants from Zimmer, outside the submitted work. Dr. Macaulay is on the editorial/governing board of Clinical Orthopaedics and Related Research and Journal of Arthroplasty, board/committee member of Hip Society, IP royalties and paid consultancy for JointMedica, unpaid consultancy for ORamaVR, stocks from OrthAlign.

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