Cemented Versus Cementless Femoral Fixation for Total Hip Arthroplasty Following Osteoarthritis

Characteristics of patients showing dislocation after total hip arthroplasty in an acute care hospital: A retrospective cohort study

Most previous studies on dislocation after total hip arthroplasty (THA) have focused on patient- and surgery-related factors without detailing the specific circumstances of dislocation events. Therefore, this study aimed to analyze dislocation cases and compare these relevant factors between patients who experienced dislocation and those who did not to inform targeted prevention measures during acute care hospitalization. This retrospective study examined the electronic medical records of 420 patients (445 joints) who underwent THA and rehabilitation at our hospital between April 1, 2018, and August 31, 2023. A total of 9 cases of dislocation in 6 patients were reported. Dislocation occurred most frequently in bed within the patient's room (5 cases; 55.6%), followed by in the rehabilitation room and the toilet (1 case each; 11.1%), and unknown locations (2 cases; 22.2%). Bed-related dislocations were associated with trunk rotation or external rotation of the hip joint; in 2 cases, the dislocation was already present when the patient awoke. The revision THA and THA indication rates, preoperative Functional Independence Measure scores, and locomotion status differed significantly between the patients who showed dislocation and those who did not. Revision THA, THA indications other than osteoarthritis, low Functional Independence Measure score at admission, and low locomotion status may increase the risk of dislocation. Furthermore, the findings suggest that dislocation prevention strategies during acute hospitalization should prioritize safe bed use and sleep positions.

To Cement or Not? Ten-Year Results of a Prospective, Randomized Study Comparing Cemented versus Cementless Total Knee Arthroplasty

BACKGROUND

The optimal mode of fixation for total knee arthroplasty (TKA) continues to be a subject of debate.

METHODS

There were 100 cases enrolled to compare cemented and cementless TKA using a modular trabecular metal tibia. This is a report on the 91 cases with follow-up information, including 67 cases with a minimum 10-year follow-up: 36 cases in the cemented cohort (A) and 31 cases in the cementless cohort (B). We previously reported the 2- and 5-year results for this prospective, randomized trial. Knee Society Scores and Oxford scores were collected preoperatively and postoperatively.

RESULTS

The mean Knee Society Scores (94.4, 89.1, P = 0.21) and Oxford scores (44.1, 43.9, P = 0.80) were similar in both groups. Group A had two revisions at 5-year follow-up, with three additional revisions for polyethylene wear, osteolysis, and loosening at 10-year follow-up. Group B had two revisions at 5-year follow-up, with two additional revisions for polyethylene wear and instability and instability due to laxity at 10-year follow-up. In total, two group A cases and one group B case were revised for implant fixation complications. Survivorship with any revision as an end point was equivalent between the two cohorts (91.5%, 95.9%, P = 0.60), as was survivorship using tibial tray revision as an end point (93.7%, 95.9%, P = 0.55). No cases demonstrated any progressive radiolucencies. Group A had 5 cases with osteolysis (80% tibial), and Group B had two cases of osteolysis (0% tibial).

CONCLUSIONS

Cementless and cemented TKA had equivalent patient-reported outcomes and survivorship at 10-year follow-up. Cemented fixation had a higher rate of osteolysis and loosening, which may be related to increased third-body wear. Cementless fixation shows immense potential as a successful option for many patients. Updates to this study cohort are planned at 15- and 20-year intervals to obtain longer-term outcomes.

Decreased Revision Risk with Cementless Collared Metadiaphyseal-Filling Stems Compared to Cemented Fixation in Patients 65 Years and Older

BACKGROUND

Compared to other cementless designs, collared metadiaphyseal-filling femoral stems are associated with a lower risk of revision and periprosthetic femoral fracture after total hip arthroplasty (THA) in patients ≥ 65 years. However, it is unclear how these designs compare to cemented femoral stems. We utilized the American Joint Replacement Registry (AJRR) to examine the risk of revision comparing cementless collared metadiaphyseal-filling versus cemented femoral stem designs.

METHODS

Data from 2012 to 2021 was analyzed in patients ≥ 65 years, linked to Centers for Medicare and Medicaid data. We identified 79,022 primary THAs, stratified into two groups: cementless collared metadiaphyseal-filling stems (n = 61,854) and cemented fixation (n = 17,168). Inverse-probability-of-treatment-weighting (IPTW) cause-specific Cox proportional hazard models were used to evaluate the risks of all-cause revision and revision for periprosthetic femoral fracture, aseptic loosening, dislocation, and infection.

RESULTS

Compared to cemented stems, cementless collared metadiaphyseal-filling stems showed a lower risk of all-cause revision (hazard ratio [HR] 0.46, 95% confidence interval [CI] 0.38 to 0.56, P < 0.001), aseptic loosening (HR 0.35, CI 0.22 to 0.57, P < 0.001), dislocation (HR 0.39, CI 0.26 to 0.58, P < 0.001), and infection (HR 0.53, CI 0.36 to 0.78, P = 0.001). There was no difference in periprosthetic femoral fracture risk (HR 0.80, CI 0.45 to 1.42, P = 0.44).

CONCLUSION

In this cohort of patients undergoing primary THA, cementless collared metadiaphyseal-filling stems were associated with decreased risk of all-cause revision, revision for aseptic loosening, dislocation, and infection, but there was no difference in periprosthetic femoral fracture risk compared to cemented stems. Further study of cementless collared metadiaphyseal-filling designs compared to cemented fixation is warranted as there may be benefits of decreased revision risk with cementless fixation.

Vancouver B Fractures After Using Cementless Femoral Fixation: A Single Center Experience

BACKGROUND

Cementless stems have been the predominant type of femoral component used for total hip arthroplasty (THA) in the United States for several decades. However, recent literature has reported an increased periprosthetic fracture (PPFx) rate and complications associated with these components, particularly among older patients. This study evaluated the incidence and outcome of Vancouver B PPFx after primary THA using cementless stems.

METHODS

A single institution's database was used to identify 12,400 primary THAs performed from 2009 through 2023. The mean age at surgery was 64 years, and 57% of THAs were performed among women. All postoperative PPFx were identified, and those classified as Vancouver B were evaluated for treatment method and secondary reoperations.

RESULTS

Among 72 postoperative PPFx, 34 were classified as Vancouver B for an overall rate of 0.3% (34 of 12,400). The median time from THA to Vancouver B PPFx was 33 days. Patients aged > 75 years at surgery had a higher rate of Vancouver B PPFx (0.6%, 13 of 2,094) compared to patients aged 18 to 75 years at surgery (0.2%, 21 of 10,306, P < 0.001). Type C3 triple-taper collared titanium stems had a lower fracture rate (0.1%, four of 4,748) compared to Type A flat taper stems (0.7%, 23 of 3,105, P < 0.001). In patients over 75 at surgery, Type C3 stems had a lower fracture rate (0.3%, three of 923) compared to Type A stems (1.5%, seven of 472, P = 0.04). There were 28 patients who had Vancouver B fractures (82%) who underwent reoperation. Secondary reoperations were performed among 25% (seven of 28) of THAs, and three of these involved periprosthetic joint infection.

CONCLUSIONS

Consistent with other reports, the Vancouver B PPFx rate was higher in patients aged > 75 years at surgery. At our institution, Type C3 triple-taper collared titanium stems lowered the PPFx fracture rate in all age groups, including those over age 75 years at surgery. Secondary reoperations remain highly morbid to patients.

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

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.