Document Detail


What works best, a cemented or cementless primary total hip arthroplasty?: minimum 17-year followup of a randomized controlled trial.
MedLine Citation:
PMID:  20625950     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Total hip arthroplasty (THA) has been associated with high survival rates, but debate remains concerning the best fixation mode of THA.
QUESTIONS/PURPOSES: We conducted a randomized controlled trial (RCT) with 250 patients with a mean age of 64 years between October 1987 and January 1992 to compare the results of cementless and cemented fixation.
PATIENTS AND METHODS: Patients were evaluated for revision of either of the components. One hundred twenty-seven patients had died (51%) and 12 (4.8%) were lost to followup. The minimum 17-year followup data (mean, 20 years; range, 17-21 years) for 52 patients of the cementless group and 41 patients of the cemented group were available for evaluation.
RESULTS: Kaplan-Meier survivorship analysis at 20 years revealed lower survival rates of cemented compared with cementless THA. The cementless tapered stem was associated with a survivorship of 99%. Age younger than 65 years and male gender were predictors of revision surgery.
CONCLUSIONS: The efficacy of future RCTs can be enhanced by randomizing patients in specific patient cohorts stratified to age and gender in multicenter RCTs. Including only younger patients might improve the efficacy of a future RCT with smaller sample sizes being required. A minimum 10-year followup should be anticipated, but this can be expected to be longer if the difference in level of quality between the compared implants is smaller.
LEVEL OF EVIDENCE: Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Authors:
Kristoff Corten; Robert B Bourne; Kory D Charron; Keegan Au; Cecil H Rorabeck
Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial     Date:  2010-07-13
Journal Detail:
Title:  Clinical orthopaedics and related research     Volume:  469     ISSN:  1528-1132     ISO Abbreviation:  Clin. Orthop. Relat. Res.     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-24     Completed Date:  2011-01-25     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  0075674     Medline TA:  Clin Orthop Relat Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  209-17     Citation Subset:  AIM; IM    
Affiliation:
London Health Sciences Centre, University Campus, 339 Windermere Road, London, ON N6A 5A5, Canada.
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MeSH Terms
Descriptor/Qualifier:
Adult
Age Factors
Aged
Arthroplasty, Replacement, Hip / adverse effects,  instrumentation*,  methods*
Bone Cements / therapeutic use*
Female
Follow-Up Studies
Hip Joint / physiopathology,  radiography,  surgery*
Hip Prosthesis*
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Ontario
Osteoarthritis, Hip / physiopathology,  radiography,  surgery*
Proportional Hazards Models
Prosthesis Design
Prosthesis Failure
Reoperation
Risk Assessment
Risk Factors
Sex Factors
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Bone Cements
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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