Long-term durability of cemented primary total hip arthroplasty

Area of Science:

• Orthopedic Surgery
• Biomaterials Engineering
• Geriatric Medicine

Background:

• Cemented total hip arthroplasty (THA) has been a common procedure.
• Long-term outcomes of early cemented THA designs require evaluation.
• Understanding factors influencing implant survival is crucial for patient selection and surgical planning.

Purpose of the Study:

• To evaluate the 15-year survival and revision rates of primary cemented total hip arthroplasties.
• To identify predictors of implant failure, specifically patient age and etiology.
• To assess the correlation between radiographic loosening and clinical failure.

Main Methods:

• Retrospective review of 597 primary cemented THAs performed between 1974-1982 with at least 1-year follow-up.
• Analysis of implant survival, aseptic revision rates, and sepsis-related revisions.
• Statistical analysis to determine the impact of patient age and primary etiology on implant failure.

Main Results:

• Overall 15-year implant survival was 82%.
• Age at surgery was a significant predictor of failure: 15-year aseptic revision rates were 37% (age <50), 17% (age 50-60), and 4% (age >60).
• Radiographic loosening occurred in 45% of patients but was not a reliable indicator of clinical failure, with only 49% requiring revision.

Conclusions:

• Cemented THA demonstrates excellent long-term results in older patients (>60).
• Younger patients (<50) exhibit markedly inferior outcomes with significantly higher revision rates.
• Cemented hip arthroplasty remains a viable option, particularly for elderly individuals, given its success with established techniques.