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

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Jämsen, Esa Eskelinen, Antti Peltola, Mikko Mäkelä, Keijo
Spatial Coverage	Finland
Description	Author Affiliation: Jämsen E ( Coxa, Hospital for Joint Replacement, PO Box 652, 33101, Tampere, Finland, esa.jamsen@uta.fi.)
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.
File Format	HTM / HTML
ISSN	0009921X
e-ISSN	15281132
DOI	10.1007/s11999-014-3641-7
Journal	Clinical Orthopaedics and Related Researchtextregistered
Issue Number	9
Volume Number	472
Language	English
Publisher	Springer
Publisher Date	2014-09-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Orthopaedics Arthroplasty, Replacement, Hip Hip Prosthesis Osteoarthritis, Hip Surgery Postoperative Complications Epidemiology Registries Cementation Finland Mortality Prosthesis Design Prosthesis Failure Radiography Reoperation Retrospective Studies Survival Rate Time Factors
Content Type	Text
Resource Type	Article
Subject	Orthopedics and Sports Medicine Surgery Sports Science

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