Swedish register cemented vs uncemented

Uncemented and cemented primary total hip arthroplasty in the Swedish Hip Arthroplasty Register.

Hailer NP, Garellick G, Kärrholm J. Acta orthopaedica 2010 · PMID 20180715 · doi:10.3109/17453671003685400

Question

Do uncemented total hip replacements survive as well as cemented ones in a national population?

Design

Population-based cohort study from the Swedish Hip Arthroplasty Register.

Patients

Patients recorded in the Swedish Hip Arthroplasty Register with fully cemented or fully uncemented primary THA.

Intervention

Uncemented THA

Comparison

Cemented THA

Primary outcome

Revision for any reason and for aseptic loosening

Key result

Uncemented THA had significantly lower revision-free survival than cemented THA, mainly because of poorer uncemented cup performance; uncemented stems did better than cemented stems, though unrecognised intraoperative femoral fractures may cause early stem failure, and the commonest modern uncemented cups performed similarly to cemented cups.

Limitations

Observational registry data with selection bias towards uncemented implants in younger patients, and many included designs are no longer used.

Impact on practice

Supports cemented or hybrid fixation, particularly in older patients, and informed the Scandinavian and UK preference for cemented components.