Comparison of cemented and uncemented fixation in total hip replacement: a meta-analysis.
BACKGROUND
The choice of optimal implant fixation in total hip replacement (THR)--fixation with or without cement--has been the subject of much debate.


METHODS
We performed a systematic review and meta-analysis of the published literature comparing cemented and uncemented fixation in THR.


RESULTS
No advantage was found for either procedure when failure was defined as either: (A) revision of either or both components, or (B) revision of a specific component. No difference was seen between estimates from registry and single-center studies, or between randomized and non-randomized studies. Subgroup analysis of type A studies showed superior survival with cemented fixation in studies including patients of all ages as compared to those that only studied patients 55 years of age or younger. Among type B studies, cemented titanium stems and threaded cups were associated with poor survival. An association was found between difference in survival and year of publication, with uncemented fixation showing relative superiority over time.


CONCLUSIONS
While the recent literature suggests that the performance of uncemented implants is improving, cemented fixation continues to outperform uncemented fixation in large subsets of study populations. Our findings summarize the best available evidence qualitatively and quantitatively and provide important information for future research.
Morshed
Saam
S
Department of Orthopaedic Surgery, School of Medicine, University of California-San Francisco, San Francisco, CA 94143, USA. morsheds@orthosurg.ucsf.edu
Bozic
Kevin J
KJ
Ries
Michael D
MD
Malchau
Henrik
H
Colford
John M
JM
D000328:Adult; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D001843:Bone Cements; D002484:Cementation; D002986:Clinical Trials as Topic; D019317:Evidence-Based Medicine; D006622:Hip Prosthesis; D006801:Humans; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D016032:Randomized Controlled Trials as Topic; D012086:Reoperation; D016896:Treatment Outcome
D001843:Bone Cements