Cementless femoral prostheses cost more to implant than cemented femoral prostheses.
Prosthetic cost contributes greatly to the overall expense of THA. A key question, therefore, in the selection of implant technique is whether any price difference exists between a cementless and a cemented femoral prosthesis. We evaluated the price difference between the most commonly used cemented and cementless femoral stems at three high-volume academic medical centers. Each hospital's costs for prostheses from the manufacturers were recorded. The average cost of implanting a cementless femoral prosthesis was $296 more than the average cost of implanting a cemented femoral stem, even with the additional expense of two batches of bone cement and the accessories commonly used to achieve a third-generation cementing technique. The price difference was less variable if the cost of the prostheses from only the primary implant supplier for each institution was considered. As the number of THAs performed per year continues to escalate, implantation of a cemented femoral component remains an attractive method of fixation from an economic standpoint.


METHODS
Level III, economic and decision analysis. See the Guidelines for Authors for a complete description of levels of evidence.
Unnanuntana
Aasis
A
Department of Orthopaedics, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44118, USA. uaasis@yahoo.com
Dimitroulias
Apostolos
A
Bolognesi
Michael P
MP
Hwang
Katherine L
KL
Goodman
Stuart B
SB
Marcus
Randall E
RE
D000046:Academic Medical Centers; D019644:Arthroplasty, Replacement, Hip / Q000191:economics* / Q000295:instrumentation*; D001843:Bone Cements / Q000191:economics*; D003365:Costs and Cost Analysis; D005269:Femur / Q000601:surgery*; D006622:Hip Prosthesis / Q000191:economics*; D006801:Humans
D001843:Bone Cements
J Arthroplasty. 1995 Apr;10(2):133-40
7798093
Acta Chir Orthop Traumatol Cech. 2006 Jun;73(3):145-50
16846558
Orthopade. 2006 Jul;35(7):761-4, 766-8
16683130
J Bone Joint Surg Am. 2001 Dec;83(12):1840-8
11741064
J Bone Joint Surg Br. 1992 May;74(3):385-9
1587883
Ann Surg. 1998 Sep;228(3):429-38
9742926
J Bone Joint Surg Am. 2007 Apr;89(4):814-8
17403805
J Bone Joint Surg Br. 1990 Sep;72(5):757-60
2211749
J Bone Joint Surg Am. 2008 Jun;90(6):1290-6
18519323
J Bone Joint Surg Am. 2008 Feb;90(2):299-306
18245589
Clin Orthop Relat Res. 2007 Apr;457:57-63
17242613
J Arthroplasty. 2007 Dec;22(8):1187-92
18078889
Acta Orthop. 2007 Jun;78(3):315-26
17611843
J Arthroplasty. 2006 Jan;21(1):102-5
16446193
Orthopedics. 2003 Aug;26(8 Suppl):s833-6
12934737
Clin Orthop Relat Res. 2001 Dec;(393):137-46
11764343
J Bone Joint Surg Am. 1993 Apr;75(4):581-7
8478385
J Bone Joint Surg Am. 2002 Sep;84(9):1636-41
12208922
J Bone Joint Surg Am. 2004 Jan;86(1):92-7
14711950
J Bone Joint Surg Am. 1993 Jul;75(7):961-75
8240489
Pediatrics. 1998 Jun;101(6):963-9
9606220
J Bone Joint Surg Am. 2001 Nov;83(11):1622-9
11701783
J Bone Joint Surg Br. 2000 Apr;82(3):378-82
10813173
Mayo Clin Proc. 1992 Nov;67(11):1066-74
1434866
J Bone Joint Surg Am. 1999 Jan;81(1):74-82
9973057
Ann Rheum Dis. 1999 Sep;58(9):569-72
10460191
J Arthroplasty. 2000 Oct;15(7):928-33
11061455
Lancet. 1986 Apr 5;1(8484):769-71
2421120
J Bone Joint Surg Am. 2007 Aug;89(8):1874-85
17671035
J Bone Joint Surg Am. 2007 Jan;89(1):126-32
17200319
J Arthroplasty. 1994 Oct;9(5):481-7
7807104
J Bone Joint Surg Am. 1988 Jul;70(6):878-82
3392086
Acta Orthop Belg. 1997;63 Suppl 1:93-5
9532859
J Arthroplasty. 1996 Jun;11(4):373-6
8792242
J Bone Joint Surg Am. 1993 Mar;75(3):321-5
8444909
J Bone Joint Surg Am. 1999 Feb;81(2):247-55
10073588
Clin Orthop Relat Res. 2005 Aug;(437):152-6
16056043