Perioperative and short-term outcomes of cemented versus cementless total hip arthroplasty: a retrospective propensity-matched analysis

Background: Cement fixation for total hip arthroplasty (THA) remains a controversial topic. While cemented stems are associated with lower risk of periprosthetic fractures (PPF), cementless stems may offer superior biological fixation. This study analyzed peri-operative and short-term outcomes of cemented vs. cementless stem fixation in THA.

Methods: A retrospective review was conducted on 15,012 patients who underwent primary elective THA at an academic medical center from 2011 to 2021. Of these patients, 429 were cemented. Patients were stratified into 3 age cohorts (25-69, 70-79 and ≥ 80 years). Cemented stem patients were 1:1 propensity-score matched to cementless stem patients for baseline characteristics. Perioperative and short-term outcomes were compared.

Results: The mean operative time for cemented cases was significantly longer across all age cohorts (25-69, P = 0.005; 70-79, P < 0.001; ≥80, P < 0.001). In the 70-79 and ≥ 80 cohorts, cemented patients demonstrated a significantly shorter length of stay (LOS) compared to cementless patients (2.2 vs. 2.6 days, P = 0.017; 3.0 vs. 3.4, P = 0.041, respectively). In the 70-79 and ≥ 80 cohorts, cemented patients were significantly more likely to be discharged home when compared to cementless patients (88.2 vs. 80.5%, P = 0.031; 64.0 vs. 54.2%, P = 0.046, respectively). Across age cohorts, there were no differences in all-cause revision rates (Cohort 1: 5.4% vs. 1.1%, P = 0.108; Cohort 2: 3.0% vs. 1.8%, P = 0.362; Cohort 3: 1.8% vs. 1.2%, P = 0.714). The ≥ 80 cohort demonstrated increased rates of PPF in the cementless cohort compared to cemented (1.2 vs. 0%, P = 0.082, respectively), but it did not reach significance.

Conclusion: Patient age has a substantial impact on perioperative outcomes following cemented versus cementless stem THA. Patients > 70 with a cemented femoral stem had improved perioperative outcomes such as shorter LOS, increased discharge to home and reduced rates of PPF compared to their cementless stem counterparts. Patient age should be considered prior to selecting a stem fixation strategy.

Level of evidence: III, Therapeutic Study.