Use of Cementless or Cemented Stems in One-Stage Exchange for Periprosthetic Joint Infection in Total Hip Arthroplasty Does Not Affect Outcomes: A Propensity-Matched Cohort Study From an Institutional Registry with a Mean Follow-Up of Six Years.

Abstract

Periprosthetic joint infection (PJI) is the most dramatic complication of total hip arthroplasty (THA). We investigated whether a one-stage arthroplasty using a cemented or uncemented stem was associated with better survival in terms of infection and mechanical complications. Patients were selected from a PJI institutional registry of THA between 2003 and 2019. After matching the two groups by propensity score at a 1:3 ratio, 241 patients were finally included: 62 in the cemented group and 179 in the cementless group. The mean age of the population was 68 years (range, 25.1 to 91.4), and 45.2% (109 of 241) of the patients were women, with a mean body mass index of 26.9 (range, 15.6 to 46.4). The mean follow-up was 6.6 years (range, 0.1 to 18.1). To compare the overall survival rate between groups, Kaplan-Meier analysis was performed. The overall survival rate in our series was 93.3% [88.2 to 98.7] at 10 years. At the last follow-up, nine THAs had been reinfected: four relapses and five new infections. Regarding the reinfection-free survival rate, there was no significant difference (P = 0.62) between the cemented group (95.8% [90.2 to 100.0]) and the cementless group (94.1% [87.8 to 100.0]) at 10 years. At the last follow-up, 34 (14.1%) THAs had aseptic complications that required 30 revisions. Regarding the aseptic survival rate, there was no significant difference (P = 0.61) between the cemented group (81.8% [71.1 to 94.0]) and the cementless group (83.3% [72.8 to 95.2]) at 10 years. To our knowledge, this study is the first to compare outcomes between cemented and cementless stems in one-stage exchange PJI. There is no difference in reinfections or mechanical complication rates when a cemented or cementless stem is used in a 1-stage revision THA exchange for PJI. Other parameters, in particular the shape of the femur and the patient's co-morbidities, must be taken into account when choosing the type of stem to use.