Clinical Review
Prevention of Venous Thromboembolism After Total Joint Replacement: Rivaroxaban Update
Clinical trials have shown that rivaroxaban is superior to enoxaparin, the current standard of care, in preventing venous thromboembolism after...
Uncemented hip replacements have gained popularity and are increasingly being used in the U.S. However, that popularity may be undeserved and in opposition to the data, say researchers from Turku University Hospital, Helsinki University, and The Coxa Hospital for Joint Replacement in Tampere, all in Finland; Haukeland University Hospital and the University of Bergen, both in Bergen, Norway; Odense University Hospital and Aarhus University Hospital, both in Denmark; the University of Gothenburg in Mölndal and Skåne University Hospital in Lund, both in Sweden; and Massachusetts General Hospital in Boston.
All types of fixation techniques have excellent track records of survivorship, including traditional cemented implants. Nevertheless, the increased use of uncemented implants has been influenced by reports from experts in single centers with good outcomes, the researchers say. They also add that intense marketing of the more expensive uncemented implants may be a factor in their growing popularity.
In their study, the researchers analyzed data from patients in the multinational Nordic Arthroplasty Register Association database, including 347,899 total hip replacements. Of those, 232,603 used cemented implants, 71,454 patients used uncemented, 28,215 hips were hybrid (uncemented cup with cemented stem), and 15,627 used reverse hybrid (cemented cup and uncemented stem). The mean follow-up time was 7 years (range, 0-17) for cemented, 4.9 years (range, 0-17) for uncemented, 7.5 years for hybrid, and 3.4 years for reverse hybrid.
The researchers found that the 10-year survival of cemented implants in patients aged 65 to 74 years and aged ≥ 75 years was higher than that of uncemented, hybrid, and reverse hybrid implants. For example, 95.9% of cemented implants survived at 10 years in patients aged ≥75 years compared with 93% of uncemented, 93.9% of hybrid, and 93.2% of reverse hybrid. The survival of cemented replacements in patients aged 55 to 64 years was similar.
Moreover, during the first 6 months, the risk of revision was lower with cemented implants than with that of all other types of fixation in all age groups.
Source
Mäkelä KT, Matilainen M, Pulkkinen P, et al. BMJ. 2014;348:f7592.
doi: 10.1136/bmj.f7592.