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Clinical Orthopaedics and Related Research®

, Volume 469, Issue 1, pp 209–217 | Cite as

What Works Best, a Cemented or Cementless Primary Total Hip Arthroplasty?: Minimum 17-year Followup of a Randomized Controlled Trial

  • Kristoff Corten
  • Robert B. BourneEmail author
  • Kory D. Charron
  • Keegan Au
  • Cecil H. Rorabeck
Clinical Research

Abstract

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 twenty-seven 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.

Keywords

Revision Rate Cementless Fixation Future Randomized Control Trial Cementless Group Specific Patient Cohort 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

We thank Andreas Laupacis for his outstanding work in setting up this study. We also thank Ann Belmans, department of Biostatistics, KU Leuven, Belgium, for excellent support and advice in the statistical evaluations of this study.

Supplementary material

11999_2010_1459_MOESM1_ESM.doc (55 kb)
Supplementary material 1 (DOC 55 kb)
11999_2010_1459_MOESM2_ESM.doc (104 kb)
Supplementary material 2 (DOC 104 kb)
11999_2010_1459_MOESM3_ESM.doc (104 kb)
Supplementary material 3 (DOC 104 kb)
11999_2010_1459_MOESM4_ESM.doc (118 kb)
Supplementary material 4 (DOC 117 kb)
11999_2010_1459_MOESM5_ESM.doc (67 kb)
Supplementary material 5 (DOC 67 kb)

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Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  • Kristoff Corten
    • 1
  • Robert B. Bourne
    • 1
    Email author
  • Kory D. Charron
    • 1
  • Keegan Au
    • 1
  • Cecil H. Rorabeck
    • 1
  1. 1.London Health Sciences CentreUniversity CampusLondonCanada

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