Perioperative, short-, and long-term mortality related to fixation in primary total hip arthroplasty: a study on 79,557 patients in the Norwegian Arthroplasty Register (original) (raw)
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Risk of early mortality after cemented compared with cementless total hip arthroplasty
The Bone & Joint Journal, 2017
Aims It has been suggested that cemented fixation of total hip arthroplasty (THA) is associated with an increased peri-operative mortality compared with cementless THA. Our aim was to investigate this through a nationwide matched cohort study adjusting for age, comorbidity, and socioeconomic background. Patients and Methods A total of 178 784 patients with osteoarthritis who underwent either cemented or cementless THA from the Swedish Hip Arthroplasty Register were matched with 862 294 controls from the general population. Information about the causes of death, comorbidities, and socioeconomic background was obtained. Mortality within the first 90 days after the operation was the primary outcome measure. Results Patients who underwent cemented THA had an increased risk of death during the first 14 days compared with the controls (hazard ratio (HR) 1.3, confidence interval (CI) 1.11 to 1.44), corresponding to an absolute increase in risk of five deaths per 10 000 observations. No suc...
Uncemented and cemented primary total hip arthroplasty in the Swedish Hip Arthroplasty Register
Acta Orthopaedica, 2010
Background and purpose Since the introduction of total hip arthroplasty (THA) in Sweden, both components have most commonly been cemented. A decade ago the frequency of uncemented fixation started to increase, and this change in practice has continued. We therefore analyzed implant survival of cemented and uncemented THA, and whether the modes of failure differ between the two methods of fixation.
Patient-Reported Outcomes in Cemented and Uncemented Total Hip Replacements
Hip International, 2016
ORiGinAl ReSeARCH ARTiCle with uncemented fixation, others have adopted these newer uncemented technologies more cautiously (3). Epidemiological estimates in the United States have suggested that 86% of primary THRs are uncemented, with less than 1% fully cemented (4). In contrast, many countries with national registers perform uncemented THRs at a frequency of less than 50%; Sweden (15%), Norway (25%), and England and Wales (43%) (5). These countries favour cemented fixation based on registry data identifying a lower risk of revision in patients undergoing cemented THR, particularly for patients above 75 years (6). Paradoxically, there has been increasing use of uncemented fixation worldwide (5). Several factors may contribute to the increasing use of uncemented fixation in primary THR. Shorter operation time, good documentation of some uncemented designs, and large cohort studies have favored uncemented fixation (7). Despite register data identifying inferior implant survival with uncemented fixation for all implants, recent research, including some registry reports, indicate similar implant survival for cemented and uncemented fixation when comparing the 5 most common combinations of modern implants (7).
BMC Musculoskeletal Disorders
Background Hip hemiarthroplasty (HHA) is a common treatment for hip fractures in the elderly population. Because of the fatal effects of bone cement implantation syndrome, the safety of cement utilization to enhance implant firmness in the femur is controversial. The aim of this study was to investigate the postoperative survival of elderly patients receiving HHA with and without cement fixation. Methods Claim data from the National Health Insurance Database and the National Register of Deaths Database were used for analysis in this retrospective cohort study. From 2008 to 2014, 25,862 patients aged 80 years or older treated with hip hemiarthroplasty were included in the analysis. A Cox proportional risk model was used to analyse the effects of cement utilization on postoperative mortality. Results The cemented group had a significantly higher mortality risk than the non-cemented group within 7, 30, 180 days and 1 year after the operation. The effect of bone cement on postoperative ...
Acta orthopaedica, 2016
Background and purpose - According to previous Nordic Arthroplasty Register Association (NARA) data, the 10-year implant survival of cemented total hip arthroplasties (THAs) is 94% in patients aged 65-74 and 96% in patients aged 75 or more. Here we report a brand-level comparison of cemented THA based on the NARA database, which has not been done previously. Patients and methods - We determined the rate of implant survival of the 9 most common cemented THAs in the NARA database. We used Kaplan-Meier analysis with 95% CI to study implant survival at 10 and 15 years, and Cox multiple regression to assess survival and hazard ratios (HRs), with revision for any reason as endpoint and with adjustment for age, sex, diagnosis, and femoral head material. Results - Spectron EF THA (89.9% (CI: 89.3-90.5)) and Elite THA (89.8% (CI: 89.0-90.6)) had the lowest 10-year survivorship. Lubinus (95.7% survival, CI: 95.5-95.9), MS 30 (96.6%, CI: 95.8-97.4), and C-stem THA (95.8%, CI: 94.8-96.8) had a ...
Medical journal of islamic world academy of sciences, 2020
Total hip arthroplasty (THA) is one of the most common orthopedic surgeries (1). Pioneered by Sir John Charnley, THA has become a widely accepted surgical practice owing to advances in design and metallurgy, a better understanding of biology, and novel surgical techniques. The initial cemented THA prosthetic applications were associated with problems such as intraoperative hypotension, sudden death, aseptic loosening, and periprosthetic bone loss in young patients (2,3). This has led researchers to seek new designs, and uncemented prosthetics are widely preferred (4). Both cemented and uncemented designs have their own sets of advantages and disadvantages. This study aimed to compare the clinical and radiological outcomes of cemented, uncemented, and hybrid THA applications. MATERIAL AND METHODS The study was designed as a single-center and retrospective trial. Patients who underwent THA between April 1995 and December 2001 at the Tepecik Training and Research Hospital were included in the study. All the researchers who participated in the study signed the most recent version of the Helsinki Declaration. The informed consent form was obtained from the patients in the study. During the indicated time frame, 53 total hip arthroplasties were performed in the center on 48 patients. Patients followed up for at least 2 years were included in this study. Seven of the surgical patients opted out of follow-up, while 20 patients were excluded from the study due to insufficient follow-up time. Therefore, 23 total hip arthroplasties of 21 patients were evaluated in the study.
Hemiarthroplasty of the Hip with and without Cement: A Randomized Clinical Trial
Journal of Bone and Joint Surgery, 2012
Background: Controversy exists regarding the use of cement for hemiarthroplasty to treat a displaced subcapital femoral neck fracture in elderly patients. The primary hypothesis of this study was that use of cement would provide better visual analog pain scores following this procedure in an elderly patient population. Methods: Elderly patients (at least seventy years of age) without severe cardiopulmonary compromise who presented to one institution with a displaced subcapital femoral neck fracture were offered inclusion in the study. One hundred and sixty patients (mean age, eighty-five years) with an acute displaced femoral neck fracture were randomly allocated to hemiarthroplasty with either a cemented Exeter or an uncemented Zweymüller Alloclassic component. Clinical and radiographic follow-up was performed for two years and the outcomes were recorded by a blinded assessor. The main clinical outcome measures were pain, mortality, mobility, complications, reoperations, and quality of life measured with use of validated instruments. Results: The mean visual analog pain score at rest did not differ significantly between the groups. The total number of complications was greater in the uncemented group (sixty-three compared with twenty-eight in the cemented group). Subsidence was significantly more common in the uncemented group (eighteen compared with one in the cemented group). Intraoperative or postoperative fracture was also significantly more common in the uncemented group (eighteen compared with one in the cemented group). The mortality rate did not differ significantly between the groups at any time point (thirty-five deaths in the uncemented group compared with thirty-two in the cemented group at two years). The Oxford hip score was significantly poorer in the uncemented group at six weeks (38.8 compared with 35.7 in the cemented group), and it was also poorer or similar at later follow-up time points although the differences were not significant. There was also a trend toward poorer mobility and greater dependence on walking aids in the cemented group. The postoperative Short Musculoskeletal Function Assessment and Mini-Mental State Examination scores did not differ significantly between the groups. Conclusions: In elderly patients (seventy years or older) without severe cardiopulmonary compromise who were treated