Abstract

INTRODUCTION: With the overwhelming use of cementless femoral fixation for primary THA in the United States, the associations of stem fixation on the risk of revision and mortality are poorly understood. We evaluated the relationship between femoral fixation and risk of revision and mortality in patients included in the AJRR.METHODS: Elective, primary, unilateral THAs in the AJRR, in patients over the age of 65 years were considered. 9612 patients with a cemented stem were exact matched 1:1 with patients who received a cementless stem based on age, sex, and the Charlson Comorbidity Index. Outcomes compared between the groups included need and reason for revision at 90-days and one-year; in-hospital, 90-day, and one-year mortality; and mortality after early revision. Covariates were used in linear regression analyses.RESULTS: Cemented fixation was associated with a 37% reduction in the risk of 90-day revision, and a reduction in the risk of revision for periprosthetic fracture of 87% at 90 days and 81% at one year. Cemented fixation was associated with increased 90-day and one-year mortality (OR:3.15[CI:2.24-4.43] and 2.36[CI:1.86-3.01], respectively). Patients who underwent subsequent revision surgery within the first year exhibited the highest mortality risk (OR:3.23, CI:1.05-9.97).CONCLUSIONS: In this representative sample of the United States, 90-day revision for any reason and for periprosthetic fracture was significantly reduced in patients with a cemented stem. This benefit must be weighed against the association with increased mortality; and with the high risk of mortality associated with early revision, which was more prevalent with cementless fixation.

View details for DOI 10.1016/j.arth.2022.01.088

View details for PubMedID 35131391