Cementless Hip Replacement Research Articles

High Grade Osteosarcoma at the Site of a Ceramic on Cross-Linked Polyethylene Cementless Hip Replacement: A Case Report and Review of the Literature

The following case report describes a 50-year-old male with a history of post-traumatic arthritis of the right hip after a previous open reduction of a traumatic hip dislocation as a young adult. He underwent an uncomplicated ceramic on highly cross-linked polyethylene primary total hip arthroplasty (THA), with unremarkable intra-operative pathology at that time. Three years postoperatively, the patient developed acute onset of hip and groin pain and associated radiographic findings which proved to be related to a high-grade osteosarcoma within the soft tissue juxtaposed to the ceramic on highly cross-linked polyethylene THA. While metal-associated primary bone sarcomas have been previously reported, we are unaware of any prior description of an osteosarcoma in the setting of a ceramic on highly cross-linked polyethylene articulation. This current report represents the first case of a primary osteosarcoma associated with this type of hip arthroplasty articulation.

An assessment of the return to professional activity of patients aged ≤30 years after hip replacement surgery.

The study evaluated the professional activity of patients after a total cementless hip replacement surgery performed at the age of ≤30 years. The study group comprised 87 patients, with 95 total cementless hip replacements. The mean age was 25.7 years. The youngest patient was 17 years old, and the oldest 30 years old. The mean length of observation was 20.1 years, ranging 5-33 years. All patients underwent clinical and radiological evaluations before the surgery, and again in the third, sixth and twelfth months after the surgery. Further follow-up visits were performed every year. The tests were scored according to the Merle d'Aubigné and Postel (MAP) classification, as recommended by the Polish Society of Orthopaedics and Traumatology. Postoperative radiographs were used to assess the position of the endoprosthesis, and the degree of implant healing in the bone tissue. The data was subjected to statistical analysis. Of the surveyed group, 67 patients were professionally active before the surgery: 34 were white-collar workers, 29 manual workers, and 4 students or school pupils. The remaining 20 had not worked for many years, and were receiving sickness or disability benefits. An excellent result, according to the Kellgren-Lawrence classification, was noted in 22 cases, a good result in 42 cases, and a satisfactory result in 6 cases. In 25 cases, a poor result was observed. All of the patients professionally active before the surgery returned to work following the procedure. A further analysis found that 15 previously-unemployed patients commenced employment following the procedure. The mean length of the sick leave was 196.2 days, and rehabilitation payments were granted in 5 cases. Total cementless hip replacement is a valuable method of treating osteoarthritis in young patients. All of the patients who worked before the surgery returned to work in the same position and on the same employment conditions. Most of the previously-unemployed patients commenced employment following the procedure. Int J Occup Med Environ Health. 2021;34(6):747-54.

Comparative study of suction drainage placement in cementless hip replacement among patients undergoing extended thromboprophylaxis: a prospective randomized study

BackgroundThe use of drains reportedly does not improve surgical outcomes after hip replacement. There is still a lack of strict recommendations for drain placement after primary hip replacement. This study aimed to assess the safety of not using suction drainage after primary hip replacement in a population of patients undergoing extended thromboprophylaxis.MethodsIn this prospective randomized study, all patients were qualified for primary hip replacement and were divided into two groups: with and without drainage. The inclusion criterion was idiopathic hip osteoarthritis. The exclusion criteria were secondary coxarthrosis, autoimmune disease, coagulopathy, venous/arterial thrombosis, hepatic/renal insufficiency, cement, or hybrid endoprostheses. We performed an intention-to-treat analysis. Clinical, laboratory, and radiographic parameters were measured for the first three days after surgery. Hematoma collection, due to extended thromboprophylaxis, in the joint and soft tissues was evaluated precisely. The patients underwent follow-up for 30 days.ResultsThe final analysis included a total of 100 patients. We did not find any significant statistical differences between groups in terms of hip fluid collection (9.76 vs. 10.33 mm, with and without drainage, respectively; mean difference, 0.6 mm; 95 % confidence interval [CI] -2.8 to 3.9; p = 0.653), estimated blood loss (1126 vs. 1224 ml; mean difference, 97.1 ml; 95 % CI -84.1 to 278.2; p = 0.59), and hemoglobin levels on postoperative day 3 (11.05 vs. 10.85 g/dl; mean difference, 0.2; 95 % CI -2.1 to 2.5; p = 0.53). In addition, the other parameters did not show significant differences between groups. Notably, two cases of early infections were observed in the no-drainage group, whereas there were no such complications in the drainage group.ConclusionsWe conclude that the use of closed suction drainage after primary hip replacement is a safe procedure in patients undergoing extended thromboprophylaxis. Further research is warranted to validate these findings.Trial registrationThe study was successfully registered retrospectively at Clinicaltrial.gov with the identification number NCT04333264 03 April 2020.

Long-term Results of the Thrust Plate Prosthesis, 21-year Follow-up: A Case Report and Literature Review

Introduction:The thrust plate prosthesis (TPP) is a type of cementless hip replacement. Aimed to preserve femoral diaphyseal bone, it was favored by some orthopedic surgeons in younger patients as they could potentially undergo multiple revision arthroplasties during their lifetime. Of particular note, the preserved diaphyseal bone allows for the implantation of a subsequent primary total hip arthroplasty (THA).Case Report:We reported on a 64-year-old male patient who underwent thrust plate prosthesis (TPP) implantation 21 years ago (1999) for the treatment of primary osteoarthritis (OA) of the right hip joint. At 21-year follow-up, he had not developed any post-operative complications, and he reported a SF12 score of 32 and Oxford hip score of 47/48.Conclusion:TPP proved to be successful clinically and radiologically, especially in the young patient. It loads directly to the cortex of the proximal femoral metaphysis as in a native hip joint. It is a bone preserving prosthesis which allows for good bone stock in the case of revision surgery that was a victim of commercial considerations.

Time efficiency of direct anterior hip arthroplasty compared to postero-lateral approach in elderly patients.

IntroductionPrimary arthroplasty of the hip joint is currently one of the most commonly performed procedures in orthopedics. In Poland we are observing significant changes in the age structure. With the prolonged life more and more elderly patients require musculoskeletal surgery to maintain comfortable and painless mobility. Reducing the duration of the procedure reduces the costs of anesthesiology, surgical and instrument teams, as well as the operating room technical team. The aim of the study was to compare the time required to perform hip joint arthroplasty by the direct anterior approach (DAA) with the postero-lateral approach (PLA) in our hospital.Material and methodsA retrospective analysis of 559 total and bipolar cemented and cementless hip replacement procedures based on two operative approaches – the minimally invasive DAA over the course of 2 years, and the standard PLA over the course of 3 years – was performed.ResultsStatistically significant differences were observed between the approaches used for cementless total arthroplasty with regard to the mean treatment times: 51.9 min for the 272 DAA cases, and 78.3 min for the 190 PLA cases (p < 0.0001). For the cementless hemi-arthroplasty procedure, the mean treatment times were 46.9 min in 36 patients for DAA, and 48.2 min for 61 patients for PLA (p = 0.57).ConclusionsMinimally invasive DAA significantly shortens the time of the procedure in elderly patients compared to PLA. Further study is needed to analyze other aspects of those two approaches.

Quality of Life of Men after Cementless Hip Replacement - a Pilot Study.

Hip osteoarthritis is a significant health, social and economic problem. The associated pain and pathological and pathological proliferative joint lesions significantly reduce patients' quality of life. The study involved 61 male patients aged 30 to 75 years qualified for hip arthroplasty due to osteoarthritis. A short version of the WHOQoL-BREF and EQ-5D-5L questionnaires were used to assess the quality of life. The questionnaires were administered before surgery, during the first outpatient visit (6 weeks after the surgery) and 6 months after the surgery. The WHOQoL-BREF questionnaire showed that the quality of life had improved significantly after just 6 weeks by 5% and 19% (p &lt;0.01). After 6 months, there was also an improvement, of 13% and 42% (p &lt;0.001). The most marked statistical improvement was found in the somatic domain after 6 weeks (8%) and after 6 months (11%) (p &lt;0.001). The quality of life according to the EQ-5D-5L questionnaire showed statistically significant improvement of 13-23% after 6 weeks and of 32-42% after 6 months (p &lt;0.001). The most marked improvement was achieved in terms of pain relief (p &lt;0.001). 1. The quality of life improved significantly after just six weeks following hip arthroplasty. 2. The results were significantly higher also after 6 months. 3. The functional status of the patients improved significantly at both 6 weeks and 6 months after hip arthroplasty, especially in terms of pain reduction.

Long-term follow-up of bone remodelling after cementless hip arthroplasty using different stems

The present paper is concerned with the investigation of the phenomenon of long-term bone remodelling on cementless hip replacements. Changes in bone density in the periprosthetic region around the stem, measured by dual X–ray absorptiometry (DXA), were used as a measure of the osseous adaptation reaction. A postoperative follow-up of the use of four different types of prostheses of varying design after on average 13.3 (11.4–14.5) years. Specifically, the prostheses assessed in this study were the CLS/Spotorno stem with the Allofit cup by Zimmer, the Vision 2000 stem with the Duraloc cup by DePuy Synthes, the AlphaFit stem with the AlphaLock cup by Corin and the Mayo stem with the Trilogy cup by Zimmer. For the DXA measurement, the femur was divided into the zones suggested by Gruen et al. On the femur, there was a significant reduction in bone mineral density (BMD) in the proximal Region Of Interest (ROI) 1 (p = 0.003) and 7 (p < 0.001), whilst there was a significant increase in ROI 4 (p = 0.03). A greater degree of bone atrophy was seen in patients aged 60 years and older and in female patients. A remarkable finding when comparing the stems was a significantly greater reduction in BMD in ROI 6 (p = 0.003) in the case of the Vision 2000 stem and a markedly, but not statistically significantly smaller reduction in BMD in ROI 7 (p = 0.18) in the case of the short-stem Mayo-type prosthesis. The best clinical results were found with the use of the latter. The investigations provide a starting point for establishing a differential indication in the choice of prosthesis types, depending on age and sex, the use of short-stem prostheses, as well as the administration of bone-effective drugs for the prevention of stress shielding.

Treatment Outcomes for Periprosthetic Femoral Fractures in Cementless Press-Fit Total Hip Replacement.

The aim of this study was to report outcomes in dogs with periprosthetic femoral fractures associated with a press-fit cementless femoral total hip replacement implant. Electronic medical records and digital radiographs were used to identify dogs with periprosthetic femoral fractures associated with press-fit cementless total hip replacement. Data collected included signalment, weight, time of fracture, cause of fracture, presence of intra-operative fissure, fracture type, repair technique, and clinical and radiographic outcomes. Long-term patient outcome was assessed by communication with owners or referring veterinarians. Twenty-eight dogs with femoral fracture repair associated with cementless press-fit total hip replacement were identified. Eight of the fractures occurred intraoperatively and 20 occurred at a median of 2 days postoperatively. An oblique or spiral configuration was noted in 19 cases and 15 occurred at the distal end of the femoral stem (type B), with thirteen type B1, one type B2 and one type B3 fractures. Fractures were repaired with non-locking (18/28) or locking-plate fixation (10/28). Cerclage wire was applied around the plate and proximal bone segment in 17/28 dogs. Major complications occurred in 7/28 cases (five deep infection, two mechanical failures). Bone healing was noted in 21/23 cases, for which follow-up radiographic interpretation was available. Return to function was complete in 17 cases, acceptable in 8 cases and unacceptable in 3 cases. While cementless total hip replacement periprosthetic femoral fractures can be successfully repaired with lateral plate fixation, the risk of infection appears to be high.

Effect of acetabular cup orientation and femoral stem placement on the functional outcome in uncemented total hip arthroplasty

Background: A total joint arthroplasty refers to non-biologic replacement of articulating surfaces of a joint. The positioning of the acetabular component is a crucial step of the surgical technique. The position of the acetabular component in the medial-lateral direction influences offset leading to changes in the moment-lever arm of the abductor musculature. The anteversion of the acetabular cup in the sagittal plane and the inclination angle (also known as abduction angle) in the coronal plane are both important determinants of acetabular position. Aim: The present study was conducted to see the effect of acetabular cup orientation and femoral stem placement on the functional outcome in cementless hip replacement arthroplasty exclusively.Methodology: The present open-ended retrospective study was conducted in the Department of Orthopaedic Surgery, King George Medical University, Lucknow, UP on patients operated by uncemented total hip arthroplasty from 1st January 2012 to 30th April 2015. The following protocol was followed for every patient: -  Demographic data and clinical examination of enrolled patients was noted.  Functional outcome assessment by calculating the Harris Hip Score  Radiological Evaluation by a standard x-ray of pelvis with both hip-AP (including whole implant) Statistical tools: Final data was analyzed by SPSS v. 16. Normality of the data described by mean and SD. For comparing variables with normal distribution, paired t-test, independent t-test, and ANOVAs test were used. Qualitative variables were expressed with frequency and percent. A p value of

Polymer–Mineral Compounds for Cementless Hip Replacement

Polymer–Mineral Compounds for Cementless Hip Replacement

RADIOGRAPHIC EVALUATION OF EARLY OUTCOME AFTER TWO TYPES OF CEMENTLESS HIP ARTHROPLASTY

Introduction Total Hip Arthroplasty is one of the most common orthopaedic procedures. Its outcome is assessed by radiographic evaluation. Two principal radiographic parameters are cup inclination and stem position angle. Aim The study aimed to compare radiological outcomes of two total hip arthroplasty techniques: Alloclassic Zweymüller versus Corail Pinnacle endoprostheses. Material and methods Medical histories of 345 patients who had a hip replacement between 2007 and 2017 were reviewed. Patients with primary total hip arthroplasty with both of mentioned systems were included in the research. Seven observers individually evaluated the radiological images of the 67 endoprostheses (39 Alloclassic Zweymüller and 26 Corail Pinnacle). The cup inclination and the stem position angle were measured using MB-Ruler programme. Results There was no statistical difference (p &gt; 0.338) in cup inclination angle between Alloclassic Zweymüller and Pinnacle cups, with the angle ranging from 31.01° to 58.80° (45.20° on average) and from 30.61° to 59.1° (43.60° on average), respectively. Femoral stem position did not differ between both types of endoprosthesis (p &gt; 0.932), ranging from −1.05° to 7.87° (3.09° on average) for Alloclassic Zweymüller and 0.35° to 7.79° (3.06° on average) for Corail Pinnacle stem. ICC (Intraclass Coefficient Correlation) was estimated and their 95% confident intervals were calculated for cup inclination and stem position showing good reliability of cup inclination measurements. Conclusions Both types of endoprostheses presented similar radiological outcomes. Cup inclination can be used by non-experienced medical staff to reliably assess the postoperative radiograms. Keywords: cementless hip replacement, radiological outcomes, imaging.

Comparative cohort study of the SuperPath approach and the conventional posterior approach in primary cementless hip replacement surgery

Background and objectivesThere is no current consensus on the most suitable hip approach. However, there is a trend to reduce damage to soft tissue, which may have an influence on early outcomes. The SuperPath approach accesses the capsule maintaining integrity of the external rotators. The purpose of this study was to compare the SuperPath approach with the conventional posterior approach, in terms of early outcomes and radiological results. Material and methodsA cohort of 30 patients operated using the SuperPath approach was prospectively matched for age, gender, body mass index and hip function with 60 patients operated using a conventional posterior approach. Clinical evaluation was performed by the Harris score, Merle d’Aubigné score, reduced Western Ontario and McMasters Universities (WOMAC), Short-Form 12 (SF12), IHOT-ADV and IHOT-12 questionnaires. Radiological evaluation was also performed. ResultsPreoperatively, no significant differences were detected between cohorts. Skin-to-skin operation time and blood loss was higher in the SuperPath cohort. Length of stay was similar between cohorts. Clinical evaluation improved significantly from the preoperative values to the 1-year follow-up. At 3 months the SuperPath cohort showed better results for IHOT-12, and at 12 months for SF. Radiologically, there were no differences between cohorts. ConclusionThis prospective randomized study reveals that the learning curve for the SuperPath approach provides similar outcomes to the conventional posterior approach within the first year after surgery. The SuperPath approach was associated with longer skin-to-skin operation time, and greater blood loss.

CEMENTLESS HIP ARTHROPLASTY AFTER PROXIMAL FEMORAL FRACTURES IN ELDERLY PATIENTS: A PROSPECTIVE CASE SERIES OF 26 PATIENTS.

Background: Fractures of the proximal femur in the elderly patients represent a challenge for the orthopedic surgeons due to osteoporosis and numerous illnesses that can aggravate the morbidity and complicate treatment. Internal fixation and arthroplasty are the two main options for the treatment. The optimal treatment remains controversial. Aim of the work: The present study aimed to evaluate the early clinical and functional outcomes of cementless hip replacement in elderly patients with Fractures of the proximal femur. Patients and methods: From January 2016 to March 2018 a prospective case series study was conducted on 24 participants (26 hips) with 2 year follow up and mean age 67.19 ± 8.38 years (60- 88 years). Twenty three cases (88 %) had fracture neck femur and three cases (12 %) had intertrochanteric fracture. Twenty cases (77 %) underwent cementless THA and six cases (23 %) had cementless bipolar hip arthroplasty. Modified lateral approach was used in all patients. Main criteria for clinical assessments were Harris hip score (HHS) and The Quality of Life Scale (QOLS). Results: HHS was used for clinical evaluation of patients, prefracture and postoperatively at 6 weeks, 6 months, 1 year and 2 years. The mean postoperative HHS for all patients in the last follow up (2 years) was 86.93 ± 11.62 (range, 71- 98). On the other hand, The QOLS was used for evaluation of patient’s satisfaction. The meanpostoperative QOLS at 2 year was 86.06 ± 11.13 (range, 55- 97) with no statistically significant difference between pre-fracture and postoperative. Conclusion: The results of this study suggest that cementless hemiarthroplasty and cementless THA offers good treatment option for displaced proximal femoral fractures in the elderly with overall good functional outcomes. It gives very satisfactory results that are comparable to published data. Longer follow up is needed toelaborate stronger clinical evidence. Level of evidence: (IV) a prospective case series trial.

Bilateral hip joint arthroplasty in dysplastic hip arthritis in patients with osteopenia and osteoporosis

In severe forms of dysplastic hip arthritis (DA) total hip arthroplasty is the most effective method of treatment. Objective: to investigate the results of bilateral hip arthroplasty in patients with dysplastic hip arthritis combined with osteopenia and osteoporosis. Methods: we examined 72 women with DA after bilateral total hip. The main group included 45 patients, who had DA combined with signs of osteopenia and osteoporosis. The control group consisted of 27 patients without signs of decreased mineral bone density. The mean age of patients in the main group was (51.5 ± 2.06) years, in the control group — (43.5 ± 2.25) years. Before surgery we assessed indexes: cortical, Singh, morpho-cortical, Noble, Spotorno. We analyzed the type of the femoral canal according to Spotorno and Dorr, type of dysplastic acetabulum. Results: 90 surgeries were made in the main group of patients, of which in 86 cases (95.6 %) cementless implants were used, in 3 cases (3.3 %) — hybrid fixation, in 1 case (1.1 %) — reverse hybrid fixation was used. The patients of the control group were undergone 54 operations of cementless hip replacement. The average evaluationof the results of treatment according to Harris hip score was 88.2 in the main group, in the control group — 89.1 points. Conclusions: during the planning of hip arthroplasty in patients with bilateral DA, it is necessary to take into account the x-ray anthropometric characteristics of the proximal femur, which allow to choose the design of the femoral component of the endoprosthesis and the type of its fixation, depending on the two-planeshape of the medullary canal. The use of threaded cementless cups allow to achieve a primary stable fixation of the acetabular component of the endoprosthesis in case of dysplastic deformation of the acetabulum even at decreased bone density.

Matched cohort study of topical tranexamic acid in cementless primary total hip replacement.

Tranexamic acid has been shown to be effective in reducing blood loss after total hip replacement. The purpose of this study was to prospectively assess the effectiveness of topical TXA use to reduce blood loss after primary total hip replacement and to compare these outcomes with those of a matched control group from a similar cohort that did not have received tranexamic acid. This is a prospective matched control study to assess the effect of a 2 g topical tranexamic acid in 50mL physiological saline solution in total hip replacement. Primary outcomes were hemoglobin and hematocrit drop, and total blood loss. Secondary outcomes were transfusion rates, length of hospital stay, deep vein thrombosis, and pulmonary embolism events. We could match 100 patients to a control group. There were no statistical significantly differences between the two groups. The hemoglobin and hematocrit postoperative values were significantly higher in topical tranexamic acid group than in control group (P < 0.001). The mean total blood loss was 769 in topical tranexamic acid group and 1163 in control group with significant differences (P = 0.001), which meant 34% reduction in total blood loss. Length of stay was lower in topical tranexamic acid group. The risk of deep vein thrombosis and pulmonary events did not increase. A single dose of 2 g tranexamic acid in 50mL physiological saline solution topical administration was effective and safe in reducing bleeding in patients undergoing unilateral primary non-cemented total hip replacement compared to a matched control group.

Better early functional outcome after short stem total hip arthroplasty? A prospective blinded randomised controlled multicentre trial comparing the Collum Femoris Preserving stem with a Zweymuller straight cementless stem total hip replacement for the treatment of primary osteoarthritis of the hip

ObjectivesPrimary aim was to compare the functional results at 3 months and 2 years between short and conventional cementless stem total hip arthroplasty (THA). Secondary aim was to determine the...

Implant Design in Cementless Hip Arthroplasty.

When performing cementless hip arthroplasty, it is critical to achieve firm primary mechanical stability followed by biological fixation. In order to achieve this, it is essential to fully understand characteristics of implant design. In this review, the authors review fixation principles for a variety of implants used for cementless hip replacement and considerations for making an optimal selection.

Cementless total hip replacement without femoral osteotomy in patients with severe developmental dysplasia of the hip: minimum 15-year clinical and radiological results.

We describe the clinical and radiological results of cementless primary total hip replacement (THR) in 25 patients (18 women and seven men; 30 THRs) with severe developmental dysplasia of the hip (DDH). Their mean age at surgery was 47 years (23 to 89). In all, 21 hips had Crowe type III dysplasia and nine had Crowe type IV. Cementless acetabular components with standard polyethylene liners were introduced as close to the level of the true acetabulum as possible. The modular cementless S-ROM femoral component was used with a low resection of the femoral neck. A total of 21 patients (25 THRs) were available for review at a mean follow-up of 18.7 years (15.8 to 21.8). The mean modified Harris hip score improved from 46 points pre-operatively to 90 at final follow up (p < 0.001). A total of 15 patients (17 THRs; 57%) underwent revision of the acetabular component at a mean of 14.6 years (7 to 20.8), all for osteolysis. Two patients (two THRs) had symptomatic loosening. No patient underwent femoral revision. Survival with revision of either component for any indication was 81% at 15 years (95% CI 60.1 to 92.3), with 21 patients at risk. This technique may reduce the need for femoral osteotomy in severe DDH, while providing a good long-term functional result.

CORR Insights®: High early failure rate after cementless hip replacement in the octogenarian.

This CORR Insights® is a commentary on the article “High Early Failure Rate After Cementless Hip Replacement in the Octogenarian” by Jamsen and colleagues available at: DOI: 10.1007/s11999-014-3641-7. The author certifies that he, or a member of his 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 ® editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR ® or the Association of Bone and Joint Surgeons®. This CORR Insights® comment refers to the article available at DOI: 10.1007/s11999-014-3641-7.

High early failure rate after cementless hip replacement in the octogenarian.

Use of cementless hip replacements is increasing in many countries, but the best method for fixation for octogenarian patients remains unknown. We studied how fixation method (cemented, cementless, hybrid) affects the survival of primary hip replacements and mortality in patients 80 years or older. Specifically, we asked if fixation method affects (1) the risk of revision; (2) the reasons for revision; and (3) the mortality after contemporary primary hip replacement in octogenarian patients. A total of 4777 primary total hip replacements were performed in 4509 octogenarian patients with primary osteoarthritis in Finland between 1998 and 2009 and were registered in the Finnish Arthroplasty Register. Comorbidity data were collected from a nationwide quality register. Survival of hip replacements, using any revision as the end point, and mortality were analyzed using competing risks survival analysis and Cox regression analysis. The average followup was 4 years (range, 1-13 years). Cementless hip replacements were associated with a higher rate of early (within 1 year) revision compared with cemented hip replacements (hazard ratio, 2.9; 95% CI, 1.7-5.1), particularly in women. The difference was not explained by comorbidity or provider-related factors. Periprosthetic fracture was the leading mode of failure of cementless hip replacements. After 1 year, there were no differences in the survival rates although 10-year survival was slightly lower for cementless than cemented and hybrid hip replacements (93.9% [95% CI, 91.1%-96.7%] versus 97.4% [95% CI, 96.9%-98.0%] and 98.1% [95% CI, 96.9%-99.4%], respectively). Fixation method was not associated with mortality. Cementless fixation was associated with an increased risk of revision and did not provide any benefit in terms of lower mortality in octogenarian patients. Level II, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.