A Comparative Study on the Outcome of Cemented and Cementless Stems during Total Hip Arthroplasty Conversion in Patients with Failed Osteosynthesis of Proximal Femur Fracture.

Abstract

Purpose: Cementless femoral fixation has become widely adopted throughout the United States for primary total hip arthroplasty (THA). However, femoral fixation in conversion THA (convTHA) presents unique challenges, and optimal strategies have not been extensively studied. This study investigated differences in outcomes for cemented versus cementless femoral fixation in convTHA for patients with failed osteosynthesis after proximal femur fracture.

Materials and methods: Data was retrospectively collected for 75 patients who underwent convTHA after previous proximal femur fracture. Based on type of femoral fixation type at time of conversion, patients were sorted into two cohorts, cemented (n=19) or cementless (n=56). Demographic, surgical, and outcome variables, including revision and complication rates, were collected and compared between the cemented and cementless cohorts. Statistical analyses were performed using multivariate regression analyses.

Results: As compared to the cemented cohort, patients for whom cementless implants were chosen tended to be younger (P<0.01), male (P=0.03), and non-white (P<0.01). The cementless cohort had shorter surgical time (149.64 minutes vs. 197.16 minutes, P=0.01). No differences were noted in anesthesia type (P=0.93), surgical approach (P=0.84), or use of dual mobility implants (P=0.93). Multivariable logistic regression analysis revealed that there was no difference in length of stay (LOS), revision rate, complication rate, or discharge disposition between the cemented and cementless cohorts.

Conclusion: Our results revealed shorter operative times with cementless femoral fixation in convTHA, but no significant difference in LOS, discharge disposition, revision rate, or complication rate when compared with cemented fixation.