Total hip arthroplasty. A comparison between cemented and press-fit noncemented fixation

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Clinical Trials

Background:

• Total hip arthroplasty (THA) is a common procedure for hip joint diseases.
• Cemented and noncemented prostheses are widely used, each with distinct biomechanical properties.
• Previous studies suggested favorable outcomes for noncemented THA, prompting further investigation.

Purpose of the Study:

• To compare the clinical and radiographic outcomes of cemented (Charnley) versus noncemented (Honart Patel-Garches) total hip arthroplasty.
• To evaluate patient outcomes over a 5-year postoperative period.
• To assess the incidence of complications such as midthigh pain and mechanical loosening.

Main Methods:

• A randomized controlled trial involving 150 patients with hip osteoarthritis or rheumatoid arthritis.
• Patients were allocated to either the Charnley (cemented) or HP-Garches (noncemented) group (n=75 each).
• Evaluations included clinical assessment, objective gait analysis, and radiographic examination at 6 months, 1 year, and annually thereafter for 5 years.

Main Results:

• The Charnley group demonstrated faster initial improvement in the first two years.
• At 5 years, 79% of Charnley and 70% of HP-Garches patients had excellent or good results.
• Revision surgery was required in 6.7% of Charnley and 18.7% of HP-Garches patients, primarily for mechanical loosening. Midthigh pain was reported in 64% of the HP-Garches group.

Conclusions:

• While initial recovery was faster with cemented hip arthroplasty, long-term functional outcomes at 5 years showed no significant difference between cemented and noncemented implants.
• The higher rate of revision surgery and midthigh pain in the noncemented group warrants consideration.
• Findings challenge earlier optimistic expectations regarding press-fit noncemented total hip arthroplasties.