Perioperative and short-term outcomes of cemented versus cementless total hip arthroplasty: a retrospective propensity-matched analysis

IF 2 3区医学 Q2 ORTHOPEDICS

Archives of Orthopaedic and Trauma Surgery Pub Date : 2024-12-12 DOI:10.1007/s00402-024-05709-4

Muhammad A. Haider, Conor Garry, Vinaya Rajahraman, Isabelle Chau, Ran Schwarzkopf, Roy I. Davidovitch, William Macaulay

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引用次数: 0

Abstract

Background

Cement fixation for total hip arthroplasty (THA) remains a controversial topic. While cemented stems are associated with lower risk of periprosthetic fractures (PPF), cementless stems may offer superior biological fixation. This study analyzed peri-operative and short-term outcomes of cemented vs. cementless stem fixation in THA.

Methods

A retrospective review was conducted on 15,012 patients who underwent primary elective THA at an academic medical center from 2011 to 2021. Of these patients, 429 were cemented. Patients were stratified into 3 age cohorts (25–69, 70–79 and ≥ 80 years). Cemented stem patients were 1:1 propensity-score matched to cementless stem patients for baseline characteristics. Perioperative and short-term outcomes were compared.

Results

The mean operative time for cemented cases was significantly longer across all age cohorts (25–69, P = 0.005; 70–79, P < 0.001; ≥80, P < 0.001). In the 70–79 and ≥ 80 cohorts, cemented patients demonstrated a significantly shorter length of stay (LOS) compared to cementless patients (2.2 vs. 2.6 days, P = 0.017; 3.0 vs. 3.4, P = 0.041, respectively). In the 70–79 and ≥ 80 cohorts, cemented patients were significantly more likely to be discharged home when compared to cementless patients (88.2 vs. 80.5%, P = 0.031; 64.0 vs. 54.2%, P = 0.046, respectively). Across age cohorts, there were no differences in all-cause revision rates (Cohort 1: 5.4% vs. 1.1%, P = 0.108; Cohort 2: 3.0% vs. 1.8%, P = 0.362; Cohort 3: 1.8% vs. 1.2%, P = 0.714). The ≥ 80 cohort demonstrated increased rates of PPF in the cementless cohort compared to cemented (1.2 vs. 0%, P = 0.082, respectively), but it did not reach significance.

Conclusion

Patient age has a substantial impact on perioperative outcomes following cemented versus cementless stem THA. Patients > 70 with a cemented femoral stem had improved perioperative outcomes such as shorter LOS, increased discharge to home and reduced rates of PPF compared to their cementless stem counterparts. Patient age should be considered prior to selecting a stem fixation strategy.

Level of evidence

III, Therapeutic Study.

查看原文本刊更多论文

骨水泥与无骨水泥全髋关节置换术的围手术期和短期结果：回顾性倾向匹配分析

背景：全髋关节置换术中水泥固定仍然是一个有争议的话题。虽然骨水泥柄与较低的假体周围骨折（PPF）风险相关，但无骨水泥柄可能提供更好的生物固定。本研究分析了全髋关节置换术中骨水泥与非骨水泥固定的围术期和短期结果。方法回顾性分析2011年至2021年在某学术医疗中心接受初级选择性THA治疗的15012例患者。在这些患者中，有429例进行了骨水泥治疗。患者被分为3个年龄组（25-69岁、70-79岁和≥80岁）。在基线特征方面，骨水泥患者与无骨水泥患者的倾向性评分为1:1。比较围手术期和短期疗效。结果在所有年龄组中，骨水泥病例的平均手术时间明显更长(25-69岁，P = 0.005；70-79, P < 0.001；≥80,P < 0.001)。在70-79和≥80的队列中，与非骨水泥患者相比，骨水泥患者的住院时间（LOS）显著缩短(2.2天vs 2.6天，P = 0.017；3.0 vs. 3.4, P = 0.041)。在70-79和≥80的队列中，与非骨水泥患者相比，骨水泥患者出院回家的可能性明显更高(88.2 vs 80.5%, P = 0.031；64.0 vs. 54.2%, P = 0.046)。在不同年龄组中，全因修订率无差异(队列1:5.4% vs. 1.1%, P = 0.108；队列2:3.0% vs. 1.8%, P = 0.362；队列3:1.8% vs. 1.2%, P = 0.714)。≥80的队列显示，与骨水泥组相比，无骨水泥组的PPF发生率增加（1.2比0%，P = 0.082），但没有达到显著性。结论患者年龄对骨水泥与非骨水泥全髋关节置换术围手术期预后有重要影响。与未植入骨水泥的患者相比，植入骨水泥的患者有更好的围手术期结果，如更短的LOS，更多的出院和更低的PPF率。在选择椎弓根固定策略前应考虑患者年龄。证据水平ii，治疗性研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Archives of Orthopaedic and Trauma Surgery 医学-外科

CiteScore

4.30

自引率

13.00%

发文量

424

审稿时长

2 months

期刊介绍： "Archives of Orthopaedic and Trauma Surgery" is a rich source of instruction and information for physicians in clinical practice and research in the extensive field of orthopaedics and traumatology. The journal publishes papers that deal with diseases and injuries of the musculoskeletal system from all fields and aspects of medicine. The journal is particularly interested in papers that satisfy the information needs of orthopaedic clinicians and practitioners. The journal places special emphasis on clinical relevance. "Archives of Orthopaedic and Trauma Surgery" is the official journal of the German Speaking Arthroscopy Association (AGA).