Is osteoporosis a contraindication for cementless total hip arthroplasty in younger patients? A matched cohort analysis of 71,578 patients.

Abstract

Cementless total hip arthroplasty (THA) is traditionally favored in younger patients given its established potential in promoting osseointegration and long-term stability. Osteoporosis, however, is typically seen as a relative contraindication, especially in older patients, due to concerns about poor bone quality affecting implant integration and increasing perioperative risks. It's unclear if these concerns apply to younger osteoporotic patients, as data in this subgroup are limited. This study aims to compare postoperative outcomes in osteoporotic vs. non-osteoporotic patients under 75 undergoing cementless THA, to assess the impact of osteoporosis and inform fixation strategies for surgeons. A propensity score-matched analysis was conducted using the TriNetX database on 71,578 patients undergoing cementless primary THA, comparing those with and without osteoporosis. Primary outcomes included THA revision, periprosthetic fracture (PPF), aseptic loosening (ASL), mechanical complications, periprosthetic joint infection (PJI), and hospital readmissions at 90 days, 1 year, and 3 years. Three-year implant survivorship was evaluated using Kaplan-Meier analysis. Secondary outcomes covered common medical complications. At 3 years, the osteoporotic group showed a significantly higher risk of PPF (1.6 fold; RR: 1.601; 95 % CI: 1.239-2.067; <i>p</i> < 0.05). Other primary outcomes and all secondary outcomes were comparable across cohorts at all time points. Kaplan-Meier analysis showed no significant difference in implant survivorship (HR: 1.060; <i>p</i> = 0.687). In patients younger than 75, cementless THA resulted in comparable rates of both medical and implant-related complications at all follow-up intervals, except for an increased risk of PPF at 3 years. These findings suggest that osteoporosis may not be a strict contraindication for cementless fixation in younger patients, and with careful intraoperative assessment of bone quality and consideration of patient-specific factors, cementless THA remains a viable option for select young osteoporotic patients.<b>Level of Evidence</b>: Thereapeutic Level III.