Adverse outcomes after cemented and cementless primary elective total hip arthroplasty in 60,064 matched patients: a study of data from the Swedish arthroplasty register
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background
The choice between cemented and cementless fixation in primary elective total hip arthroplasty (THA) remains a subject of ongoing debate. However, comparisons between the two are subject to limited adjustments for patient characteristics, diagnoses, and surgical factors, as well as by limited outcome time endpoints. Our study aimed to compare the effect of femoral fixation on safety and implant survival outcomes in matched patients.
Methods
Using propensity score techniques, we matched patients undergoing cemented (n = 101,523) and cementless (n = 52,996) primary elective THA in the Swedish Arthroplasty Register based on age, sex, American Society of Anesthesiologists grade, body mass index, hospital type, and preoperative diagnosis between 2008 and 2018. We used both regression and survival models for 30, 60, and 90 days, as well as one and two years, to compare outcomes, including mortality, revision, and periprosthetic femoral fracture necessitating revision surgery. There were 30,032 cementless femoral fixations one-to-one matched with cemented ones using the Gradient Boosting Machine modeling to estimate the propensity score.
Results
Regression analyses showed that cementless fixation had lower mortality outcomes (odds ratio (OR) 0.73, 95% confidence interval (CI) 0.69 to 0.78, P < 0.001), but significantly worse revision (OR 1.51, 95% CI 1.38 to 1.65, P < 0.001) and periprosthetic femoral fracture (OR 2.40, 95% CI 1.92 to 2.99, P < 0.001). Kaplan–Meier survival models showed statistically significant lower mortality risks for uncemented fixation at the 2-year interval (hazard ratio 0.82, 95% CI 0.71 to 0.94, P = 0.006), but not at earlier endpoints. Revision and periprosthetic femoral fractures were both higher for cementless rather than cemented fixation.
Conclusions
This study found no significant differences in early mortality between cemented and cementless femoral implants. However, cementless fixation was associated with increased risks of revision and periprosthetic femoral fractures. These findings emphasize the importance of considering implant choice in the context of individual patient characteristics and surgical priorities to optimize outcomes in THA.
The choice between cemented and cementless fixation in primary elective total hip arthroplasty (THA) remains a subject of ongoing debate. However, comparisons between the two are subject to limited adjustments for patient characteristics, diagnoses, and surgical factors, as well as by limited outcome time endpoints. Our study aimed to compare the effect of femoral fixation on safety and implant survival outcomes in matched patients.
Methods
Using propensity score techniques, we matched patients undergoing cemented (n = 101,523) and cementless (n = 52,996) primary elective THA in the Swedish Arthroplasty Register based on age, sex, American Society of Anesthesiologists grade, body mass index, hospital type, and preoperative diagnosis between 2008 and 2018. We used both regression and survival models for 30, 60, and 90 days, as well as one and two years, to compare outcomes, including mortality, revision, and periprosthetic femoral fracture necessitating revision surgery. There were 30,032 cementless femoral fixations one-to-one matched with cemented ones using the Gradient Boosting Machine modeling to estimate the propensity score.
Results
Regression analyses showed that cementless fixation had lower mortality outcomes (odds ratio (OR) 0.73, 95% confidence interval (CI) 0.69 to 0.78, P < 0.001), but significantly worse revision (OR 1.51, 95% CI 1.38 to 1.65, P < 0.001) and periprosthetic femoral fracture (OR 2.40, 95% CI 1.92 to 2.99, P < 0.001). Kaplan–Meier survival models showed statistically significant lower mortality risks for uncemented fixation at the 2-year interval (hazard ratio 0.82, 95% CI 0.71 to 0.94, P = 0.006), but not at earlier endpoints. Revision and periprosthetic femoral fractures were both higher for cementless rather than cemented fixation.
Conclusions
This study found no significant differences in early mortality between cemented and cementless femoral implants. However, cementless fixation was associated with increased risks of revision and periprosthetic femoral fractures. These findings emphasize the importance of considering implant choice in the context of individual patient characteristics and surgical priorities to optimize outcomes in THA.
Date Issued
2025-07-01
Date Acceptance
2025-01-07
Citation
The Journal of Arthroplasty, 2025, 40 (7), pp.1738-1744.e2
ISSN
0883-5403
Publisher
Elsevier BV
Start Page
1738
End Page
1744.e2
Journal / Book Title
The Journal of Arthroplasty
Volume
40
Issue
7
Copyright Statement
© 2025 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/39814112
PII: S0883-5403(25)00018-X
Subjects
cemented
cementless
machine learning
propensity score matching
total hip arthroplasty
Humans
Arthroplasty, Replacement, Hip
Male
Female
Aged
Registries
Sweden
Middle Aged
Bone Cements
Reoperation
Elective Surgical Procedures
Propensity Score
Hip Prosthesis
Prosthesis Failure
Periprosthetic Fractures
Aged, 80 and over
Cementation
Postoperative Complications
Treatment Outcome
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2025-01-13