title: Risk of early mortality after cemented compared with cementless total hip arthroplasty: a nationwide matched cohort study.
abstract: OBJECTIVE
  It has been suggested that cemented fixation of total hip arthroplasty (THA) is associated with an increased peri-operative mortality compared with cementless THA. Our aim was to investigate this through a nationwide matched cohort study adjusting for age, comorbidity, and socioeconomic background.
  
  
  METHODS
  A total of 178 784 patients with osteoarthritis who underwent either cemented or cementless THA from the Swedish Hip Arthroplasty Register were matched with 862 294 controls from the general population. Information about the causes of death, comorbidities, and socioeconomic background was obtained. Mortality within the first 90 days after the operation was the primary outcome measure.
  
  
  RESULTS
  Patients who underwent cemented THA had an increased risk of death during the first 14 days compared with the controls (hazard ratio (HR) 1.3, confidence interval (CI) 1.11 to 1.44), corresponding to an absolute increase in risk of five deaths per 10 000 observations. No such early increase of risk was seen in those who underwent cementless THA. Between days 15 and 29 the risk of mortality was decreased for those with cemented THA (HR 0.7, CI 0.62 to 0.87). Between days 30 and 90 all patients undergoing THA, irrespective of the mode of fixation, had a lower risk of death than controls. Patients selected for cementless fixation were younger, healthier and had a higher level of education and income than those selected for cemented THA. A supplementary analysis of 16 556 hybrid THAs indicated that cementation of the femoral component was associated with a slight increase in mortality up to 15 days, whereas no such increase in mortality was seen in those with a cemented acetabular component combined with a cementless femoral component.
  
  
  CONCLUSIONS
  This nationwide matched cohort study indicates that patients receiving cemented THA have a minimally increased relative risk of early mortality that is reversed from day 15 and thereafter. The absolute increase in risk is very small. Our findings lend support to the idea that cementation of the femoral component is more dangerous than cementation of the acetabular component. Cite this article: Bone Joint J 2017;99-B:37-43.
authors.affiliation: Uppsala University, Institute of Surgical Sciences, Uppsala, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Garland
authors.affiliation: Swedish Hip Arthroplasty Register, and Karolinska Institute, Danderyds Hospital, Stockholm, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Gordon
authors.affiliation: Swedish Hip Arthroplasty Register, and, University of Gothenburg, Gothenburg, Sweden.
authors.forename: G
authors.initials: G
authors.lastname: Garellick
authors.affiliation: Swedish Hip Arthroplasty Register, and, University of Gothenburg, Gothenburg, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Kärrholm
authors.affiliation: Swedish Hip Arthroplasty Register, and Karolinska Institute, Danderyds Hospital, Stockholm, Sweden.
authors.forename: O
authors.initials: O
authors.lastname: Sköldenberg
authors.affiliation: Uppsala University, Institute of Surgical Sciences, Uppsala, Sweden.
authors.forename: N P
authors.initials: NP
authors.lastname: Hailer
mesh_terms: D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D001843:Bone Cements / Q000009:adverse effects*; D016022:Case-Control Studies; D002484:Cementation / Q000009:adverse effects / Q000379:methods; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery; D011183:Postoperative Complications / Q000401:mortality; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors
chemical_list: D001843:Bone Cements
keywords: Mortality; Osteoarthritis; Post-operative; Total hip arthroplasty; Total hip replacement