Is there a place for routine use of cemented acetabular fixation in primary total hip arthroplasty for osteoarthritis? Equivalence demonstrated in an analysis of 96,574 cases from the Australian Orthopaedic Association National Joint Replacement Registry.

Abstract

This study utilises Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) data to compare survivorship of total hip arthroplasty (THA) with cemented and cementless acetabular fixation. To minimise confounders, only cases using cemented polished tapered stems with metal heads and highly cross-linked polyethylene (XLPE) liners for primary diagnosis of osteoarthritis were included. AOANJRR data were analysed from 01 September 1999 to 31 December 2022. The study population included all primary conventional THA performed for osteoarthritis using a cemented polished tapered stem with a bearing surface of metal head articulating with XLPE. These procedures were divided into two groups: procedures with either cemented or cementless acetabular fixation. The analyses were undertaken using Kaplan-Meier estimates of survivorship and hazard ratios (HR) from Cox proportional hazards models. Results were stratified by age and 3 surgeon volume groups: ⩽10, 10-25, and >25 procedures per surgeon per year. There were 96,574 THAs performed for osteoarthritis using a cemented polished tapered stem included. Of these, 5,926 used cemented and 90,648 used cementless acetabular fixation. There was no difference in the rate of revision when cemented acetabular were compared to cementless acetabular procedures (HR 1.01; 95% CI, 0.86-1.18; <i>p</i> = 0.916). The most common reasons for revision surgery were similar for both fixation methods and included periprosthetic fracture, dislocation/instability and infection. There were no differences in the rate of revision when procedures were stratified by age or surgeon volume. For patients undergoing a primary THA for osteoarthritis there is no difference in the rate of revision between cemented or cementless acetabular fixation when utilising a cemented polished stem with modern bearing surfaces. The authors advocate the use of cemented acetabular fixation as a viable alternative and emphasise the need for continued teaching of the skills required to ensure the technique is not lost for future generations of orthopaedic surgeons.