Risk of early mortality after cemented compared with cementless total hip arthroplasty (original) (raw)
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Acta Orthopaedica
Perioperative (intra-or early postoperative) deaths have been reported in cemented total hip arthroplasty (THA) and hemiarthroplasty of the hip (Sierra et al. 2009, Talsnes et al. 2013, Garland et al. 2017). One reason for early mortality may be the so-called Bone Cement Implantation Syndrome (BCIS) (Donaldson et al. 2009, Olsen et al. 2014). The symptoms of BCIS are hypoxia, with or without hypotension, and/or unexpected loss of consciousness occurring at or shortly after the time of cementation, mostly in old patients with some comorbidity, and may be fatal (Olsen et al. 2014). Death is undisputedly an important adverse outcome. Thus, studying the superior mode of fixation in THA, one should also consider short-term and long-term mortality in addition to long-term revision rates. However, the complexity of several outcomes can make it difficult to conclude which fixation to choose for the individual patient scheduled for elective THA. We compared perioperative-, short-term, and long-term mortality for patients after primary, all-cemented, all-uncemented, reverse hybrid (cemented cup and uncemented stem), and hybrid (uncemented cup and cemented stem) THAs using the Norwegian Arthroplasty Register (NAR).
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.
The Iowa orthopaedic journal, 1994
OF CLINICAL RELEVANCE Randomized clinical trials are considered mandatory before a new pharmaceutical agent can be released for public consumption. Surprisingly, randomized clinical trials are virtually unheard of in assessing a new surgical procedure or device. In this study, funded by the Medical Research Council of Canada, 250 osteoarthritic patients with mainly unilateral osteoarthritis of the hip were randomized as to whether they received a cemented or cementless total hip replacement. Patients were stratified for age (under 60 or over 60 years) and surgeon (RBB or CHR). All operations were done in the same operating room, utilizing the same direct lateral approach and surgical technique. Post-operative care was the same. The patients and the two clinical observers (KL and RB) remained blinded as to whether a cemented or cementless device had been inserted. Accurate patient cost was documented for each patient's in-hospital stay, as well as out-patient costs during the first year. Cost to quality adjusted life year data was then generated, such that comparisons could be made to other medical interventions (i.e. coronary artery bypass).
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 ...
Clinical Orthopaedics and Related Research®, 2011
Background Total hip arthroplasty (THA) has been associated with high survival rates, but debate remains concerning the best fixation mode of THA. Questions/purposes We conducted a randomized controlled trial (RCT) with 250 patients with a mean age of 64 years between October 1987 and January 1992 to compare the results of cementless and cemented fixation. Patients and Methods Patients were evaluated for revision of either of the components. One hundred twentyseven patients had died (51%) and 12 (4.8%) were lost to followup. The minimum 17-year followup data (mean, 20 years; range, 17-21 years) for 52 patients of the cementless group and 41 patients of the cemented group were available for evaluation. Results Kaplan-Meier survivorship analysis at 20 years revealed lower survival rates of cemented compared with cementless THA. The cementless tapered stem was associated with a survivorship of 99%. Age younger than 65 years and male gender were predictors of revision surgery. Conclusions The efficacy of future RCTs can be enhanced by randomizing patients in specific patient cohorts stratified to age and gender in multicenter RCTs. Including only younger patients might improve the efficacy of a future RCT with smaller sample sizes being required. A minimum 10-year followup should be anticipated, but this can be expected to be longer if the difference in level of quality between the compared implants is smaller. Level of Evidence Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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).