Improved Survival of Uncemented versus Cemented Femoral Stems in Patients Aged < 70 Years in a Community Total Joint Registry
| Autor: | Thomas K. Comfort, Terence J. Gioe, Susan Mehle, John Wechter, Penny Tatman |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2013 |
| Předmět: |
musculoskeletal diseases
Male Reoperation medicine.medical_specialty Time Factors Sports medicine medicine.medical_treatment Arthroplasty Replacement Hip Minnesota Aseptic loosening Improved survival Kaplan-Meier Estimate Osteolysis Femoral stem Prosthesis Design Clinical Research Risk Factors Medicine Humans Orthopedics and Sports Medicine In patient Femur Registries Aged Proportional Hazards Models Aged 80 and over Chi-Square Distribution business.industry Age Factors Bone Cements General Medicine equipment and supplies Arthroplasty Surgery Prosthesis Failure surgical procedures operative Treatment Outcome Orthopedic surgery Female Hip Joint Hip Prosthesis business Total hip arthroplasty |
| Popis: | Aseptic loosening of the femoral stem remains a significant reason for revision in total hip arthroplasty (THA). Although stem fixation methods have changed over time, there is relatively little evidence supporting cemented or uncemented stems as more durable constructs.We examined whether there was a difference in survival to revision between cemented and uncemented THA stems (1) for any reason; (2) for aseptic loosening or loosening related to wear/osteolysis; (3) based on patient age groupings (as a proxy for patient activity level); and (4) based on procedural timeframe groupings between cemented and uncemented stems.A total of 6498 primary cemented and uncemented THAs were registered in our community total joint replacement registry between 1991 and 2011. Analysis was performed to compare age, sex, procedural timeframe, and diagnosis for both groups. Our primary outcome was revision of the stem component for aseptic loosening or loosening secondary to wear/osteolysis. Analyses were done using Wilcoxon rank sum tests, Pearson's chi-square tests, Kaplan Meier methods, and Cox regression.After adjusting for age, sex, primary diagnosis, and procedural timeframe as confounders, cemented femoral stem components were 1.63 times as likely as uncemented stems to be revised for any reason (p = 0.02) and 3.76 times as likely as uncemented stems to be revised for aseptic loosening or loosening related to wear/osteolysis (p0.001). When grouped by age, specifically in regard to revisions for aseptic loosening or loosening related to wear/osteolysis, uncemented stems had lower cumulative revision rates in patients aged70 years (p0.001) compared with cemented stems. There was a trend away from cemented fixation in our registry, which shifted from over 80% cemented stem use in 1996 to 3% in 2011.We found that uncemented stems were associated with fewer revisions for aseptic loosening in patients70 years old, but when all reasons for revision were considered, neither group demonstrated superior survival. With a mean followup of 6.5 years, longer followup is needed to verify these results over time. |
| Databáze: | OpenAIRE |
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