title: A cemented cup with acetabular impaction bone grafting is more cost-effective than an uncemented cup in patients under 50 years.
abstract: OBJECTIVE
  Acetabular deficiencies in young patients can be restored in several ways during total hip arthroplasty. Currently, cementless cups are most frequently used. Impaction bone grafting of acetabular defects is a more biological approach, but is it cost-effective in young patients on the long term?
  
  
  METHODS
  We designed a decision model for a cost-utility analysis of a cemented cup with acetabular impaction bone grafting versus an uncemented cup, in terms of cost per quality-adjusted life year (QALY) for the young adult with acetabular bone deficiency, in need for a primary total hip arthroplasty. Outcome probabilities and effectiveness were derived from the Radboud University Nijmegen Medical Centre and the Norwegian Hip Register. Multiple sensitivity analyses were used to assess the contribution of the included variables in the model's outcome.
  
  
  RESULTS
  Cemented cups with impaction bone grafting were more cost-effective compared to the uncemented option in terms of costs per QALY. A scenario suggesting equal primary survival rates of both cemented and uncemented cups still showed an effect gain of the cemented cup with impaction bone grafting, but at higher costs.
  
  
  CONCLUSIONS
  Based on this model, the first choice of treatment of the acetabular bone deficient osteoarthritic hip in a young patient is reconstruction with impaction bone grafting and a cemented cup.
authors.affiliation: Department of Orthopaedic Surgery, Radboud University Nijmegen Medical Centre, Nijmegen - The Netherlands.
authors.forename: Vincent J J F
authors.initials: VJ
authors.lastname: Busch
authors.affiliation: Department of Orthopaedic Surgery, Radboud University Nijmegen Medical Centre, Nijmegen - The Netherlands.
authors.forename: Joost
authors.initials: J
authors.lastname: Verschueren
authors.affiliation: Department for Health Evidence, Radboud University Nijmegen Medical Centre, Nijmegen - The Netherlands.
authors.forename: Eddy M
authors.initials: EM
authors.lastname: Adang
authors.affiliation: Department of Orthopaedic Surgery, The Norwegian Arthroplasty Register, Haukeland University Hospital, Haukeland - Norway.
authors.forename: Stein A
authors.initials: SA
authors.lastname: Lie
authors.affiliation: Department of Orthopaedic Surgery, The Norwegian Arthroplasty Register, Haukeland University Hospital, Haukeland - Norway.|Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen - Norway.
authors.forename: Leif I
authors.initials: LI
authors.lastname: Havelin
authors.affiliation: Department of Orthopaedic Surgery, Radboud University Nijmegen Medical Centre, Nijmegen - The Netherlands.
authors.forename: Berend W
authors.initials: BW
authors.lastname: Schreurs
mesh_terms: D000077:Acetabulum / Q000473:pathology / Q000601:surgery; D000328:Adult; D000367:Age Factors; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000191:economics* / Q000295:instrumentation / Q000379:methods*; D016025:Bone Transplantation / Q000191:economics*; D002484:Cementation; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D006622:Hip Prosthesis / Q000191:economics*; D006801:Humans; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000191:economics / Q000473:pathology / Q000601:surgery*; D011475:Prosthesis Failure; D019057:Quality-Adjusted Life Years; D055815:Young Adult