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Improved Survival of Uncemented versus Cemented Femoral Stems in Patients Aged < 70 Years in a Community Total Joint Registry

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Aseptic loosening of the femoral stem remains a significant reason for revision in total hip arthroplasty (THA). Although stem fixation methods have changed over time, there is relatively little evidence supporting cemented or uncemented stems as more durable constructs.

Questions/purposes

We examined whether there was a difference in survival to revision between cemented and uncemented THA stems (1) for any reason; (2) for aseptic loosening or loosening related to wear/osteolysis; (3) based on patient age groupings (as a proxy for patient activity level); and (4) based on procedural timeframe groupings between cemented and uncemented stems.

Methods

A total of 6498 primary cemented and uncemented THAs were registered in our community total joint replacement registry between 1991 and 2011. Analysis was performed to compare age, sex, procedural timeframe, and diagnosis for both groups. Our primary outcome was revision of the stem component for aseptic loosening or loosening secondary to wear/osteolysis. Analyses were done using Wilcoxon rank sum tests, Pearson’s chi-square tests, Kaplan Meier methods, and Cox regression.

Results

After adjusting for age, sex, primary diagnosis, and procedural timeframe as confounders, cemented femoral stem components were 1.63 times as likely as uncemented stems to be revised for any reason (p = 0.02) and 3.76 times as likely as uncemented stems to be revised for aseptic loosening or loosening related to wear/osteolysis (p < 0.001). When grouped by age, specifically in regard to revisions for aseptic loosening or loosening related to wear/osteolysis, uncemented stems had lower cumulative revision rates in patients aged < 70 years (p < 0.001) compared with cemented stems. There was a trend away from cemented fixation in our registry, which shifted from over 80% cemented stem use in 1996 to 3% in 2011.

Conclusions

We found that uncemented stems were associated with fewer revisions for aseptic loosening in patients < 70 years old, but when all reasons for revision were considered, neither group demonstrated superior survival. With a mean followup of 6.5 years, longer followup is needed to verify these results over time.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, MN, USA

    John Wechter MD & Terence J. Gioe MD

  2. St Croix Orthopaedics, PA, Stillwater, MN, USA

    Thomas K. Comfort MD

  3. HealthEast Department of Research and Education, St Paul, MN, USA

    Penny Tatman MPH & Susan Mehle BS

  4. Minneapolis Veterans Affairs Health Care Center, Section 112E, 1 Veterans Drive, Minneapolis, MN, 55417, USA

    Terence J. Gioe MD

Authors
  1. John Wechter MD
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  2. Thomas K. Comfort MD
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  3. Penny Tatman MPH
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  4. Susan Mehle BS
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  5. Terence J. Gioe MD
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Corresponding author

Correspondence to Terence J. Gioe MD.

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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at HealthEast Hospitals, St Paul, MN, USA.

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Wechter, J., Comfort, T.K., Tatman, P. et al. Improved Survival of Uncemented versus Cemented Femoral Stems in Patients Aged < 70 Years in a Community Total Joint Registry. Clin Orthop Relat Res 471, 3588–3595 (2013). https://doi.org/10.1007/s11999-013-3182-5

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  • DOI: https://doi.org/10.1007/s11999-013-3182-5

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