A Comparison of Risks and Benefits Regarding Hip Arthroplasty Fixation

Abstract

Since the field-changing invention of noncemented hip arthroplasty fixation in the 1980s, noncemented fixation has been progressively replacing cemented fixation. However, analyses of fixation frequencies reveal new patterns in cement versus noncemented preferences. Although cementation is again gaining ground in the United States, noncemented models remain the dominant fixation mode, seen in more than 90% of all hip arthroplasties. This stark preference is likely driven by concerns regarding implant durability and patient safety. Although advances in surgical techniques, intensive perioperative care, and improved instrument have evolved in both methods, data from large arthroplasty registries reveal shifting risks in contemporary hip arthroplasty, calling the use of noncemented fixation into question. Varying risk profiles regarding sex, age, or health comorbidities and morphological and functional differences necessitate personalized risk assessments. Furthermore, certain patient populations, based on the literature and data from large registries, have superior outcomes from cemented hip arthroplasty techniques. Therefore, we wanted to critically evaluate the method of arthroplasty fixation in primary hip arthroplasties for unique patient populations.

What’s New in Osteoporosis and Fragility Fractures

“…Part of the solution is related to the appropriate mechanism of implant fixation. At this time, the majority of hip arthroplasties utilize cementless fixation 28 . To better understand the issues with this technique, Berliner et al 29 examined risk factors for periprosthetic femoral fracture in cementless THA through the direct anterior approach in the intraoperative and early postoperative periods (90 days).…”

Systematic Review on the Current Situation and Development of Local Antimicrobial Agents in Revision Arthroplasty for Periprosthetic Joint Infection (PJI)

“…Cementless reconstruction benefits: The use of cementless implants may bring about to the positive results. The cementless implants gives way for better bone integration and potentially minimizes the risk of loosening and infection associated with cement (Matthias et al, 2021). These studies suggest that single-stage revision with cementless reconstruction can be a viable and effective option for treating chronic hip infections.…”

Effects of Abaloparatide on Bone Mineral Density in Proximal Femoral Regions Corresponding to Arthroplasty Gruen Zones

“…Cemented femoral components are often used to improve fixation in older individuals with osteoporosis 32 . However, cement increases operating time and may complicate implant retrieval if revision becomes necessary 33 , making preoperative normalization of BMD a potentially attractive strategy for prolonging the opportunity for a cementless approach. For patients with osteoporosis who are preparing for elective orthopaedic surgery, a time frame of 2 to 6 months has been suggested as a reasonable duration of preoperative osteoporosis therapy 34 .…”