Uncemented total hip arthroplasty in octogenarian and nonagenarian patients
- 264 Downloads
While uncemented THA has proven benefits over cemented THA, the use of uncemented components in the elderly remains controversial. The purpose of this study was to compare functional outcomes and complication rates of uncemented THA in patients aged > 80 to patients aged < 80, and determine factors that independently influence functional outcomes.
The authors evaluated 411 consecutive uncemented THAs at a follow-up of 3.1 ± 0.9 years (range 1.8–5.2), using the Oxford hip score (OHS), EuroQol 5 Dimensions (EQ-5D) score, and noting any complications. The series was divided into two age groups: elderly group (> 80, n = 142) and control group (< 80, n = 269). Uni- and multi-variable regressions were performed to test associations between outcomes and patient age, BMI, American Society of Anaesthesiologists (ASA) score, canal bone ratio (CBR) and canal flare index (CFI).
The elderly group had femora with higher CBR (p < 0.001) and lower CFI (p = 0.002). The clinical scores were significantly worse for the elderly group, with a higher OHS (p = 0.039) and a lower EQ-5D score (p = 0.009), but there were no significant differences in overall complications rates (p = 0.500). Periprosthetic fractures were observed in three elderly patients (2.1%), compared to none of the younger patients (p = 0.041). Multi-variable regressions revealed that OHS was not correlated with any of the variables, while EQ-5D score was significantly associated with BMI (p = 0.015), ASA score (p = 0.024) and CBR (p = 0.019).
Clinical outcomes of uncemented THA do not depend on patient age per se, but on more specific preoperative characteristics such as ASA score, BMI and bone quality/morphology.
KeywordsTotal hip arthroplasty Uncemented components Elderly Periprosthetic fractures Bone quality Bone morphology
The authors are grateful to Mrs Alix Courouau and Sonia Dubreuil for their assistance with data collection, to Dr Aude Michelet for her help with manuscript redaction and to Mr Luca Nover for his support with tables formatting and submission.
Compliance with ethical standards
Conflict of interest
Authors LJ, JC and JCR have received fees for educational and promotional events from DePuy-Synthes. Authors LJ and JCR have received royalties from DePuy-Synthes. GT, HG and MS have received personal fees from Artro Institute.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.
- 4.Gjertsen JE, Lie SA, Vinje T, Engesaeter LB, Hallan G, Matre K, Furnes O (2012) More re-operations after uncemented than cemented hemiarthroplasty used in the treatment of displaced fractures of the femoral neck: an observational study of 11,116 hemiarthroplasties from a national register. J Bone Joint Surg Br 94(8):1113–1119CrossRefPubMedGoogle Scholar
- 7.Thien TM, Chatziagorou G, Garellick G, Furnes O, Havelin LI, Makela K, Overgaard S, Pedersen A, Eskelinen A, Pulkkinen P, Karrholm J (2014) Periprosthetic femoral fracture within 2 years after total hip replacement: analysis of 437,629 operations in the nordic arthroplasty register association database. J Bone Joint Surg Am 96(19):e167CrossRefPubMedGoogle Scholar
- 14.Makela KT, Matilainen M, Pulkkinen P, Fenstad AM, Havelin L, Engesaeter L, Furnes O, Pedersen AB, Overgaard S, Karrholm J, Malchau H, Garellick G, Ranstam J, Eskelinen A (2014) Failure rate of cemented and uncemented total hip replacements: register study of combined Nordic database of four nations. BMJ 348:f7592CrossRefPubMedGoogle Scholar
- 16.Noble PC, Alexander JW, Lindahl LJ, Yew DT, Granberry WM, Tullos HS (1988) The anatomic basis of femoral component design. Clin Orthop Relat Res 235:148–165Google Scholar
- 21.Engh CA, Massin P, Suthers KE (1990) Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res 257:107–128Google Scholar
- 25.Skoldenberg OG, Sjoo H, Kelly-Pettersson P, Boden H, Eisler T, Stark A, Muren O (2014) Good stability but high periprosthetic bone mineral loss and late-occurring periprosthetic fractures with use of uncemented tapered femoral stems in patients with a femoral neck fracture. Acta Orthop 85(4):396–402CrossRefPubMedPubMedCentralGoogle Scholar
- 26.Stea S, Comfort T, Sedrakyan A, Havelin L, Marinelli M, Barber T, Paxton E, Banerjee S, Isaacs AJ, Graves S (2014) Multinational comprehensive evaluation of the fixation method used in hip replacement: interaction with age in context. J Bone Joint Surg Am 96(Suppl 1):42–51CrossRefPubMedPubMedCentralGoogle Scholar
- 27.Lindberg-Larsen M, Jorgensen CC, Solgaard S, Kjersgaard AG, Kehlet H, Centre LF, Lundbeck Foundation Centre for Fast-Track H, Knee Replacement Collaborative G (2017) Increased risk of intraoperative and early postoperative periprosthetic femoral fracture with uncemented stems. Acta Orthop 88(4):390–394CrossRefPubMedPubMedCentralGoogle Scholar