Aims It has been suggested that cemented fixation of total hip arthroplasty (THA) is associated with an increased peri-operative mortality compared with cementless THA. Our aim was to investigate this through a nationwide matched cohort study adjusting for age, comorbidity, and socioeconomic background.
Patients and Methods A total of 178 784 patients with osteoarthritis who underwent either cemented or cementless THA from the Swedish Hip Arthroplasty Register were matched with 862 294 controls from the general population. Information about the causes of death, comorbidities, and socioeconomic background was obtained. Mortality within the first 90 days after the operation was the primary outcome measure.
Results Patients who underwent cemented THA had an increased risk of death during the first 14 days compared with the controls (hazard ratio (HR) 1.3, confidence interval (CI) 1.11 to 1.44), corresponding to an absolute increase in risk of five deaths per 10 000 observations. No such early increase of risk was seen in those who underwent cementless THA. Between days 15 and 29 the risk of mortality was decreased for those with cemented THA (HR 0.7, CI 0.62 to 0.87). Between days 30 and 90 all patients undergoing THA, irrespective of the mode of fixation, had a lower risk of death than controls. Patients selected for cementless fixation were younger, healthier and had a higher level of education and income than those selected for cemented THA. A supplementary analysis of 16 556 hybrid THAs indicated that cementation of the femoral component was associated with a slight increase in mortality up to 15 days, whereas no such increase in mortality was seen in those with a cemented acetabular component combined with a cementless femoral component.
Conclusion This nationwide matched cohort study indicates that patients receiving cemented THA have a minimally increased relative risk of early mortality that is reversed from day 15 and thereafter. The absolute increase in risk is very small. Our findings lend support to the idea that cementation of the femoral component is more dangerous than cementation of the acetabular component.
Cite this article: Bone Joint J 2017;99-B:37–43.
A. Garland: Initiated the study and managed the ethical review board application, Performed the statistical analyses, Drafted the manuscript, Took part in designing the study and editing the manuscript.
M. Gordon: Took part in designing the study and editing the manuscript.
G. Garellick: Assisted in preparing the review board application, Took part in designing the study and editing the manuscript.
J. Kärrholm: Assisted in preparing the review board application, Took part in designing the study and editing the manuscript.
O. Sköldenberg: Took part in designing the study and editing the manuscript.
N. P. Hailer: Initiated the study and managed the ethical review board application, Performed the statistical analyses, Took part in designing the study and editing the manuscript.
The author or one or more of the authors have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article.
This article was primary edited by S. Kutty and first proof edited by J. Scott.
Supplementary material. Graphs showing crude survival during the first 90 days after the date of the operation and tables showing baseline demographic information on the hybrid subcohort and reverse hybrids, as well as adjusted split survival in hybrid and reverse hybrid arthroplasty, are available alongside the online version of this article at www.bjj.boneandjoint.org.uk
- Received April 27, 2016.
- Accepted September 1, 2016.
- ©2017 The British Editorial Society of Bone & Joint Surgery