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Acetabular Component in Total Hip Arthroplasty: Is There Evidence that Uncemented is Better?

Josephine

NURSE DIRECTOR EMERITUS
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Acetabular Component in Total Hip Arthroplasty: Is There Evidence that Uncemented is Better?
POSTER NO. P067
Bahar Adeli, BA, Philadelphia, PA
Nader Toossi, MD, Philadelphia, PA
John J. Timperley, MD, Exeter, United Kingdom
Fares S. Haddad, FRCS, London, United Kingdom
Javad Parvizi, MD, Philadelphia, PA


INTRODUCTION: At this writing, almost all total hip arthroplasties (THA) being performed in North America use cementless acetabular components. The impetus behind this trend is not well understood. The objective of this systematic review and meta-analysis was to compare the survivorships and revision rates of cemented and cementless acetabular components utilized in THA.

METHODS: Primary literature search in PubMed identified 3,488 articles of which 3,374 were excluded because of not meeting the inclusion criteria or meeting the exclusion criteria. Only English articles on primary THA, with average follow up of 10 years or longer, with either survivorship or revision rate as outcomes were included. This study consisted of 64 articles (14,505 arthroplasties) evaluating long-term outcome of cementless acetabular components, 43 papers (16,634 arthroplasties) reporting the outcome of cemented acetabular component, and seven studies (2,312 arthroplasties) comparing cemented and cementless acetabular components. Meta-analysis and logistic regression on pooled data were performed to compare these studies. Because of the heterogeneity of these studies, the meta-analysis used a random effects model, while the logistic regression included an overdispersion parameter to model high variance.

RESULTS: Meta-analysis did not find any significant difference between survivorship and revision rate of cemented and cementless acetabular component. Logistic regression detected significant differences (p <0.02) for both: estimated odds ratio (OR) of surviving a cemented implant versus a cementless one was 1.54 (95% confidence interval: 1.08-1.95), while that of revising a cemented cup versus revising a cementless one was found to be 0.54 (95% confidence interval: 0.33-0.89). The difference between the two analyses may be that meta-analysis was confined to a smaller set of studies (7 versus 107).

DISCUSSION AND CONCLUSION: Regarding our results, cemented acetabular components seem to have a better survival and lower rate of revision compared to cementless cups. The use of cementless acetabular components for better survivorship is not supported by evidence. Perhaps the ease of insertion of cementless components, the ability to utilize alternative bearing surfaces and aggressive marketing are the main reasons for the popularity of cementless THA in North America.
 

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