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The type of cement and failure of total hip replacements
B Espehaug1, O Furnes, L I Havelin
1Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen.
Insights
Hip replacement survival rates vary significantly based on cement type. CMW3 cement showed the highest failure rate in primary Charnley hip prostheses, increasing revision risk for osteoarthritis patients.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Clinical Epidemiology
Background:
- Hip arthroplasty is a common procedure for osteoarthritis.
- Implant fixation using bone cement is a critical factor in prosthesis survival.
- Previous studies suggest variations in cement performance, but specific comparisons are needed.
Purpose of the Study:
- To evaluate the long-term survival of primary Charnley hip prostheses based on the type of bone cement used.
- To identify specific cement types associated with increased failure rates, particularly aseptic loosening.
Main Methods:
- Retrospective analysis of 17,323 primary Charnley hip prostheses from the Norwegian Arthroplasty Register.
- Survival analysis using Cox regression to compare failure rates across different cement types.
- Follow-up data assessed up to ten years post-implantation.
Main Results:
- Overall ten-year revision rate was 9.2%, with 71% attributed to aseptic loosening of the femoral component.
- Prostheses cemented with CMW1 and CMW3 demonstrated significantly higher failure rates compared to gentamicin-containing Palacos.
- Adjusted failure rate ratios indicated increased risk with Simplex, gentamicin-containing CMW1, plain CMW1, and CMW3 cements.
Conclusions:
- The choice of bone cement significantly impacts the long-term survival of Charnley hip prostheses.
- CMW3 and CMW1 cements are associated with substantially higher risks of revision surgery due to aseptic loosening.
- Optimizing cement selection is crucial for improving patient outcomes in hip arthroplasty.
Abstract:
Using data from the Norwegian Arthroplasty egister, we have assessed the survival of 17 323 primary Charnley hip prostheses in patients with osteoarthritis based upon the type of cement used for the fixation of the implant. Overall, 9.2% had been revised after follow-up for ten years; 71% of the failures involved aseptic loosening of the femoral component. We observed significantly increased rates of failure for prostheses inserted with CMW1 and CMW3 cements. Using implants fixed with gentamicin-containing Palacos cement as the reference, the adjusted Cox regression failure rate ratios were 1.1 (95% CI 0.9 to 1.4) for implants cemented with plain Palacos, 1.1 (95% CI 0.7 to 1.6) for Simplex, 2.1 (95% 1.5 to 2.9) for gentamicin-containing CMW1, 2.0 (95% CI 1.6 to 2.4) for plain CMW1 and 3.0 (95% CI 2.3 to 3.9) for implants fixed with CMW3 cement. The adjusted failure rate at ten years varied from 5.9% for implants fixed with gentamicin-containing Palacos to 17% for those fixed with CMW3.