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A Review of Current Fixation Use and Registry Outcomes in Total Hip Arthroplasty: The Uncemented Paradox

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Clinical Orthopaedics and Related Research®

An Editor's Spotlight/Take 5 to this article was published on 30 April 2013

Abstract

Background

The majority (86%) of THAs performed in the United States are uncemented. This may increase the revision burden if uncemented fixation is associated with a higher risk of revision than other approaches.

Question/purposes

We sought to investigate trends for use of uncemented fixation and to analyze age-stratified risk of revision comparing cemented, hybrid, and uncemented fixation as reported by national hip arthroplasty registries.

Methods

Data were extracted from the annual reports of seven national hip arthroplasty registries; we included all national registries for which annual reports were available in English or a Scandinavian language, if the registry had a history of more than 5 years of data collection.

Results

Current use of uncemented fixation in primary THAs varies between 15% in Sweden and 82% in Canada. From 2006 to 2010 the registries of all countries reported overall increases in the use of uncemented fixation; Sweden reported the smallest absolute increase (from 10% to 15%), and Denmark reported the greatest absolute increase (from 47% to 68%). Looking only at the oldest age groups, use of uncemented fixation also was increasing during the period. In the oldest age group of each of the registries we surveyed (age older than 65 years for England-Wales; age older than 75 years in three registries), cemented fixation was associated with a lower risk of revision than was uncemented fixation.

Conclusions

Increasing use of uncemented fixation in THA is a worldwide phenomenon. This trend is paradoxic, given that registry data, which represent nationwide THA outcomes, suggest that cemented fixation in patients older than 75 years results in the lowest risk of revision.

Level of Evidence

Level II, systematic review. See Guidelines for Authors for a complete description of levels of evidence.

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Authors and Affiliations

  1. Harris Orthopaedic Laboratory, Department of Orthopedics, Massachusetts General Hospital, 55 Fruit Street, GRJ 1126, Boston, MA, 02114-2696, USA

    Anders Troelsen MD, PhD, DMSc, Erik Malchau MD, Nanna Sillesen MD & Henrik Malchau MD, PhD

  2. Department of Orthopedics, Copenhagen University Hospital, Hvidovre, Denmark

    Anders Troelsen MD, PhD, DMSc & Nanna Sillesen MD

Authors
  1. Anders Troelsen MD, PhD, DMSc
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  2. Erik Malchau MD
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  3. Nanna Sillesen MD
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  4. Henrik Malchau MD, PhD
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Corresponding author

Correspondence to Anders Troelsen MD, PhD, DMSc.

Additional information

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.

This work was performed at the Harris Orthopedic Laboratory, Department of Orthopedics, Massachusetts General Hospital, Boston, MA, USA.

Appendix

Appendix

Appendix 1 Specific age-stratified revision risks for comparison of cemented, uncemented, and hybrid (cemented femur) fixation
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Troelsen, A., Malchau, E., Sillesen, N. et al. A Review of Current Fixation Use and Registry Outcomes in Total Hip Arthroplasty: The Uncemented Paradox. Clin Orthop Relat Res 471, 2052–2059 (2013). https://doi.org/10.1007/s11999-013-2941-7

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  • DOI: https://doi.org/10.1007/s11999-013-2941-7

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