Cementless Versus Cemented Stems in Patients Aged 70 Years or Older Undergoing Total Hip Arthroplasty

Abstract

Background: Controversy exists regarding the most appropriate femoral implant selection in older patients undergoing total hip arthroplasty (THA). Our study aimed to compare the survivorship, reasons for revision, and patient-reported outcome measures of uncemented versus cemented THA in patients aged ≥ 70 years.

Methods: This retrospective study reviewed primary THAs performed on patients aged ≥ 70 years between January 1, 2007, and October 1, 2019. A total of 2,136 patients [cemented (n = 355), cementless (n = 1,781)] were included. Demographics including age in years (77 versus 83), body mass index (29 versus 26), and sex (59 versus 83% women) were different between the cementless and cemented THA cohorts, respectively. Patient characteristics, implant characteristics, revision information, mortality, and patient-reported outcome measures [Western Ontario and McMaster University Osteoarthritis Index, Veterans Rand 12 Item Health Survey (VR12), and the Harris Hip Score were collected. Kaplan-Meier survivorship was performed with all-cause, aseptic, and aseptic stem revisions as the endpoint. Change scores were calculated and compared with independent t-tests.

Results: There were no differences in the 5- and 10-year cumulative survival in the cementless and cemented THA cohorts for all-cause (P = 0.11), aseptic (P = 0.83), and aseptic stem revisions (P = 0.61). Both cohorts demonstrated excellent long-term survival for all-cause (96.8 versus 95.5), aseptic (97.8 versus 98.3), and aseptic stem (98.4 versus 98.3) revisions. There were no differences in change scores for Western Ontario and McMaster University Osteoarthritis Index (33.9 versus 35.3, P = 0.48), VR12 mental (0.56 versus 1.42, P = 0.58), VR12 physical (8.9 versus 8.0, P = 0.21), and Harris Hip (43.1 versus 44.9, P = 0.25) scores between the cementless and cemented cohorts at the latest follow-up.

Conclusions: No difference was found in survival rates of cementless compared to cemented stems for all causes and aseptic causes in patients aged ≥ 70 years undergoing elective THA. Both cementless and cemented femoral stems provide a safe and efficacious option for performing THA in older patients.

Keywords: cementless; elderly; stem fixation; survivorship; total hip arthroplasty.