title: Patient-reported outcomes in cemented and uncemented total hip replacements.
abstract: BACKGROUND
  Data from national registries have favored the use of cemented fixation in total hip replacement (THR) while other reports show no significant differences in implant survival between cemented and uncemented fixation using modern implants. It is important to investigate whether the method of fixation itself may affect patient-reported outcomes. Hence, this study sought to analyse if patient-reported outcomes measures (PROMs) differ depending on the type of fixation.
  
  
  METHODS
  Data was used from the follow-up programme of the Swedish Hip Arthroplasty Register which comprises the EQ-5D, a visual analogue scale (VAS) on hip pain, as well as a VAS addressing satisfaction with the outcome of the hip replacement.3,118 patients with uncemented THR due to primary osteoarthritis performed from 2002 to 2011 with complete 1-year follow-up were included in the study. A control group of patients with cemented THR (n = 3,118) were selected by matching on age, gender, Charnley class, and preoperative health-related quality of life.
  
  
  RESULTS
  After adjusting for age, gender, Charnley class, and baseline PROMs, multivariate linear regression analyses showed that uncemented fixation is associated with a larger improvement in EQ-5D index (B = 0.03, 95% CI 0.019, 0.041), EQ VAS (B = 2.58, 95% CI 1.65, 3.51), greater pain relief (B = -2.68, 95% CI -3.54, -1.82) and superior patient satisfaction (B = -2.56, 95% CI -3.52, -1.60) (all p&lt;0.001).
  
  
  CONCLUSIONS
  This study demonstrates that uncemented fixation is associated with better patient-reported outcomes. Factors unrelated to implant fixation, such as performance or selection bias, may also contribute to the difference.
authors.affiliation: Swedish Hip Arthroplasty Register, Gothenburg - Sweden.|Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Gothenburg - Sweden.|Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston - USA.
authors.forename: Ola
authors.initials: O
authors.lastname: Rolfson
authors.affiliation: Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston - USA.
authors.forename: Gabrielle S
authors.initials: GS
authors.lastname: Donahue
authors.affiliation: Swedish Hip Arthroplasty Register, Gothenburg - Sweden.|Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Gothenburg - Sweden.
authors.forename: Mattias
authors.initials: M
authors.lastname: Hallsten
authors.affiliation: Swedish Hip Arthroplasty Register, Gothenburg - Sweden.|Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Gothenburg - Sweden.
authors.forename: Göran
authors.initials: G
authors.lastname: Garellick
authors.affiliation: Swedish Hip Arthroplasty Register, Gothenburg - Sweden.|Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Gothenburg - Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Kärrholm
authors.affiliation: Swedish Hip Arthroplasty Register, Gothenburg - Sweden.|Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Gothenburg - Sweden.
authors.forename: Szilard
authors.initials: S
authors.lastname: Nemes
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D005260:Female; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip; D010147:Pain Measurement; D000071066:Patient Reported Outcome Measures; D011788:Quality of Life; D012042:Registries; D013548:Sweden; D016896:Treatment Outcome; D064232:Visual Analog Scale