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01.09.2014 | Clinical Research | Ausgabe 9/2014

Clinical Orthopaedics and Related Research® 9/2014

High Early Failure Rate After Cementless Hip Replacement in the Octogenarian

Zeitschrift:
Clinical Orthopaedics and Related Research® > Ausgabe 9/2014
Autoren:
MD, PhD Esa Jämsen, MD, PhD Antti Eskelinen, MSc Mikko Peltola, MD, PhD Keijo Mäkelä
Wichtige Hinweise
One of the authors (EJ) has received funding from the Competitive State Research Financing of the Expert Responsibility Area of Tampere University Hospital (Tampere, Finland) (grant 9P016).
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.
Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.
Each author certifies that his or her institution waived approval for this investigation, and that all investigations were conducted in conformity with ethical principles of research.
This work was performed at the Coxa, Hospital for Joint Replacement, Tampere, Finland.
A comment to this article is available at http://​dx.​doi.​org/​10.​1007/​s11999-014-3667-x.

Abstract

Background

Use of cementless hip replacements is increasing in many countries, but the best method for fixation for octogenarian patients remains unknown.

Questions/purposes

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.

Methods

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).

Results

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.

Conclusions

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 of Evidence

Level II, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

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