Higher fracture risk after THA with cementless prosthesis

Editor's Note

This study led by researchers from the Hospital for Special Surgery, New York City, finds that total hip arthroplasty (THA) performed with a cementless prosthesis for a femoral neck fracture led to a higher rate of a second fracture and revision surgery.

The multicenter analysis included 709 THAs (199 cemented, 510 cementless) for femoral neck fractures. Patients were categorized according to the Dorr classification system used to evaluate femoral bone quality (ie, Dorr type A, B, or C, with C indicating the weakest bone).

Cementless implants had a higher all-cause aseptic femoral revision rate (5.1% vs 0.5%) and periprosthetic femoral fracture rate (4.3% vs 0%).

Each successive Dorr type had a higher fracture rate with cementless implants—2.3% for Dorr A, 3.7% for Dorr B, and 15.9% for Dorr C.

There were no differences in dislocation, septic revision, or mortality rates between groups.

All of the fractures requiring revision surgery occurred with cementless implants, suggesting that cemented implants may minimize this complication, the researchers says.