Comparison of total hip arthroplasty performed with and without cement : a randomized trial.
BACKGROUND
This study was designed to compare the fixation of a Mallory-Head total hip prosthesis with and without cement.


METHODS
Two hundred and fifty patients with osteoarthritis of the hip were randomized to receive a Mallory-Head total hip prosthesis designed for insertion with cement or the same prosthesis designed for insertion without cement. Neither the patient nor the outcomes assessor was aware of the type of prosthesis. Outcomes were assessed with respect to mortality, revision arthroplasty, health-related quality of life (evaluated with the Harris hip score, Merle d'Aubign  and Postel hip score, McMaster-Toronto Arthritis Patient Preference Disability Questionnaire (MACTAR), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and the time trade-off technique), and the six-minute-walk test. Patients were seen at three, six, and twelve months and yearly thereafter.


RESULTS
The prosthesis was inserted with cement in 124 patients and without cement in 126 patients. The mean age of the patients was sixty-four years, 48% were female, and the mean duration of follow-up was 6.3 years. There were thirteen revisions in the group that had fixation with cement and six in the group that had fixation without cement (p = 0.11), and more femoral components were revised in the group that had fixation with cement (twelve versus one; p = 0.002). All health-related quality-of-life measures improved postoperatively in both groups.


CONCLUSIONS
In this randomized trial, the group that had the cemented Mallory-Head hip prostheses required more revisions of the femoral component than did the group with the cementless Mallory-Head prostheses, which was perhaps related to the titanium-alloy femoral stem. Our findings are specific to the implants evaluated in this study.
Laupacis
Andreas
A
Clinical Evaluative Sciences, Toronto, Ontario, Canada. alaupacis@ices.on.ca
Bourne
Robert
R
Rorabeck
Cecil
C
Feeny
David
D
Tugwell
Peter
P
Wong
Cindy
C
D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D001843:Bone Cements; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery*; D010147:Pain Measurement; D011336:Probability; D011474:Prosthesis Design; D017755:Prosthesis Fitting; D011788:Quality of Life; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D012086:Reoperation / Q000706:statistics & numerical data; D012494:Sampling Studies; D016896:Treatment Outcome
D001843:Bone Cements