Abstract
Background and purpose — The use of cementless total hip arthroplasty (THA) in elderly patients is debated because of increased risk of early periprosthetic femoral fractures. However, cemented femoral components carry a risk of bone cement implantation syndrome. Hence, we compared in-hospital complications, complications leading to readmission and mortality ≤ 30 days postoperatively between hybrid/cemented (cemented femoral component) vs. cementless THA in osteoarthritis patients > 70 years.Patients and methods — This is a prospective observational cohort study in 9 centers from January 2010 to August 2017. We used 30-day follow-up from the Danish National Patient Registry, patient records, and data from the Danish Hip Arthroplasty Register. Only THAs performed as a result of osteoarthritis were included.Results — 3,368 (42%) of the THAs were cemented/hybrid and 4,728 (58%) cementless. The in-hospital complication risk was 7.7% after cemented/hybrid vs. 5.3% after cementless THA (< 0.001), statistically not significant when adjusting for comorbidities (p = 0.1). There were similar risks of complications causing readmission (5.7% vs. 6.2%) and mortality ≤ 30 days (0.2% vs. 0.3%). 15 cases (0.4%) of pulmonary embolism (PE) were found after cemented/hybrid vs. 4 (0.1%) after cementless THA (p = 0.001); none occurred within 24 hours postoperatively. 2 of the PEs after cementless THA led to mortality. Cemented/hybrid THA remained significantly associated with risk of PE (RR 3.9, p = 0.02), when adjusting for comorbidities. BMI > 35 was associated with highest risk of PE (RR 5.7, p = 0.003). The risk of periprosthetic femoral fracture was 0.2% after cemented/hybrid vs. 1.5% after cementless THA (p < 0.001) and the risk of dislocations was 1.2% after cemented/hybrid THA vs. 1.8% after cementless THA (p = 0.04).Interpretation — The higher risk of PE after cemented/hybrid THA and higher risk of periprosthetic femoral fractures and dislocations after cementless THA highlights that both medically and surgically complications are related to fixation technique and have to be considered.
Highlights
Martin LINDBERG-LARSEN 1,2, Pelle Baggesgaard PETERSEN 3, Christoffer Calov JØRGENSEN 1,3, Søren OVERGAARD 2, and Henrik KEHLET 1,3, + Lundbeck Foundation Center for Fast-track Hip and Knee Arthroplasty Collaborating Group
Interpretation — The higher risk of pulmonary embolism (PE) after cemented/ hybrid total hip arthroplasty (THA) and higher risk of periprosthetic femoral fractures and dislocations after cementless THA highlights that both medically and surgically complications are related to fixation technique and have to be considered
The use of cementless implants in THA has increased in all age groups including the elderly (AOANJRR 2018, DHR 2018, NJR 2018) despite the fact that cementless femoral components are associated with increased risk of early periprosthetic femoral fractures, especially in patients > 70 years (Makela et al 2014, Thien et al 2014, Lindberg-Larsen et al 2017, Tanzer et al 2018)
Summary
This is a prospective observational cohort study on patients from the Lundbeck Foundation Centre for Fast-track THA and TKA database (LCDB 2019). Data on 9,037 primary unselected elective THA procedures performed in patients > 70 years were prospectively collected between February 2010 and August 2017 in 9 departments reporting to the LCDB. Supplementary data on fixation technique, duration of surgery, indication, and previous surgeries were available from the Danish Hip Arthroplasty Registry (DHR 2018) in 98% of cases. 8,096 primary elective THA procedures performed in patients with primary osteoarthritis were available for analysis after exclusions (Figure 1). Reverse hybrid THA procedures (cementless femoral component and cemented acetabular component) were excluded. All patients with a LOS of > 4 days had their medical records examined to determine the reason for prolonged LOS and in-hospital complications during primary admission.
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