Do Rerevision Rates Differ After First-time Revision of Primary THA With a Cemented and Cementless Femoral Component?

Abstract

Background Worldwide use of cementless fixation for total hip arthroplasty (THA) is on the rise despite some evidence from the world's registries suggesting inferior survivorship compared with cemented techniques. The patterns of bone loss associated with failed cementless and cemented THAs may prejudice the results of future revision procedures; however, this has not been documented. Questions/purposes The purpose of this study was to compare (1) the risk for rerevision of first revision THA; (2) the patterns of femoral bone loss at the time of first revision of primary THA; (3) the reasons for first revision of primary THA; and (4) the time to first revision of primary THA between primary cementless and cemented femoral components. Methods Primary THAs with cemented (n = 1791) and uncemented (n = 805) femoral components that subsequently sustained first revision of the femoral component were identified from the Danish Hip Arthroplasty Registry (DHR). As of 2012, 120,988 primary THAs and 19,282 revisions were registered in the DHR with completeness of 97% and 90% for primary and revision THA, respectively. Median followup for revisions of primary THA with cemented and cementless femoral component was 4 years (range, 0-17 years) and 2 years (range, 0-16 years), respectively. Survival of first revision THA, with second revision of the femur as outcome, was evaluated using hazard ratios (HRs) with 95% confidence interval (CI) adjusting for potential confounding. All patient-and surgery-related data are collected from Danish medical databases. Recording of bone defects in the DHR is based on surgeons' intraoperative findings. Results With the numbers studied, we found no differences in the risk of second revision between the overall cohort between cementless and cemented techniques (HR, 1.32; 95% CI, 0.97-1.80; p = 0.076); however, a second revision for 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 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. Conclusions We found no differences in the risk of second revision in the overall cohort between cementless and cemented techniques; however, we observed an increased risk for rerevision THA performed on patients \ 70 years whose index THAs were performed using cementless components when looking at all causes for revision, even after adjusting for the most likely confounding factors. Our data suggest that increased use of cemen...

Clinical Faceoff: Where Are We Going With Femoral Stem Fixation in THA?

“…Further, we have previously shown in our research [3] that the implant survival after revision surgery (with second revision as an endpoint) is better for primary THA that were cemented. Therefore, an economic incentive to increase the use of cemented fixation could even be evident beyond the first revision.…”

Outcome of revision hip arthroplasty in patients younger than 55 years: an analysis of 1,037 revisions in the Dutch Arthroplasty Register

“…Survival at 5-year follow-up was lower when compared with the available literature on young patients (Lee et al 2014, Gromov et al 2015, Te Stroet et al 2015. Few papers ana- Table 3.…”

Acrylic bone cement in total joint arthroplasty: A review

“…Increased use of cementless fixation in primary THA may lead to inferior survivorship of first revision THA . Serious problems with cementless cup design are polyethylene wear and osteolysis, especially in cups with unplugged screw holes and low‐quality liners .…”

“…Cementless THA procedures have been associated with higher bone mineral density compare to cemented counterparts . There is an increased risk for re‐revision THA performed on patients younger than 70 years of age . Cemented fixation is also reported to achieve better functional outcome, less residual pain, and lower reoperation rates than cementless fixation in hemiarthroplasty .…”