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World J Orthop. Nov 18, 2014; 5(5): 591-596
Published online Nov 18, 2014. doi: 10.5312/wjo.v5.i5.591
Survival outcomes of cemented compared to uncemented stems in primary total hip replacement
Michael Wyatt, Gary Hooper, Christopher Frampton, Alastair Rothwell
Michael Wyatt, Gary Hooper, Christopher Frampton, Alastair Rothwell, Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, Canterbury 8011, New Zealand
Author contributions: Wyatt M, Hooper G and Rothwell A wrote article; Frampton C contributed to statistical analysis.
Correspondence to: Michael Wyatt, BSc(Hons), MBChB, MRCS(Ed), Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, 2 Riccarton Avenue, Christchurch 4710, Canterbury 8011, New Zealand.
Telephone: +64-3-3640640 Fax: +64-3-3640806
Received: April 11, 2014
Revised: May 28, 2014
Accepted: June 18, 2014
Published online: November 18, 2014

Total hip replacement (THR) is a successful and reliable operation for both relieving pain and improving function in patients who are disabled with end stage arthritis. The ageing population is predicted to significantly increase the requirement for THR in patients who have a higher functional demand than those of the past. Uncemented THR was introduced to improve the long term results and in particular the results in younger, higher functioning patients. There has been controversy about the value of uncemented compared to cemented THR although there has been a world-wide trend towards uncemented fixation. Uncemented acetabular fixation has gained wide acceptance, as seen in the increasing number of hybrid THR in joint registries, but there remains debate about the best mode of femoral fixation. In this article we review the history and current world-wide registry data, with an in-depth analysis of the New Zealand Joint Registry, to determine the results of uncemented femoral fixation in an attempt to provide an evidence-based answer as to the value of this form of fixation.

Keywords: Primary total hip replacement, Femoral fixation, Cemented, Uncemented, Joint replacement registry, Implamt survival

Core tip: There has been a worldwide trend towards uncemented fixation in total hip replacement yet paradoxically cemented fixation has the highest survival rate when failure has been defined as a revision of the primary implant for aseptic loosening. However closer analysis of registry data shows that revision for aseptic loosening is low with uncemented total hip replacement, and in particular revision of uncemented stems is the lowest in young patients under 65 years, who would be expected to have higher physical demands with higher failure rates secondary to loosening.