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The association between type of bone cement and revision surgery after primary elective total hip arthroplasty : a
Kevin Deere1, Epaminondas M Valsamis2,3, Adrian Sayers1
1Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK.
Aims:
Bone cement continues to be part of the fixation strategy for a large proportion of all total hip arthroplasties (THAs) in the UK and other countries. The aim of this study was to investigate the association between specific commercially available bone cement formulations and the risk of revision surgery after primary elective THA.
Methods:
This was a population-based cohort study using data from the National Joint Registry from 1 April 2003 to 31 December 2024. All consenting patients having a cemented, hybrid, or reverse hybrid primary THA for osteoarthritis were included. Multilevel over-dispersed piecewise Poisson models were used to compare the rate of revision surgery by cement type adjusted for implant type, age, sex, and American Society of Anesthesiologists grade.
Results:
A total of 515,433 procedures were included, mean patient age was 71.31 years (SD 9.5), and 63% (n = 324,962) were female. In total, 21 different cement types were used. Compared to Heraeus Medical Palacos R+G high-viscosity (68.2% of all procedures), we did not observe a different incidence rate ratio for most cement types commonly used in contemporaneous practice. However, DePuy CMW3 medium viscosity with gentamicin (incidence rate ratio (IRR) 2.21 (95% CI 1.75 to 2.75)), DePuy CMW1 high viscosity with gentamicin (IRR 1.27 (95% CI 1.08 to 1.49)), Schering-Plough HMP low viscosity with gentamicin (IRR 1.78 (95% CI 1.06 to 2.96)), Biomet Optipac Refobacin R medium viscosity with gentamicin (IRR 1.36 (95% CI 1.07 to 1.72)), and Stryker Simplex medium viscosity (IRR 1.24 (95% CI 1.04 to 1.47)) were associated with a significantly increased rate of revision surgery.
Conclusion:
Most cement types in contemporaneous practice have similar incidence rate ratios of revision to the reference cement (Heraeus Medical Palacos R+G high viscosity), but five cement types were associated with a significantly higher rate of revision. Vigilance is required as new cements are introduced into the market.
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