Debate«FOR/AGAINST»

Cemented vs uncemented fixation in total hip replacement

Anna Terentjeva RSU MF IVVlada Meļņikova RSU MF IV

Riga, 2016

Cemented fixation technique in total hip replacement (THR)(1)

http://www.jointreplacementvizag.com/images/home/joint-replacement-services/total-hip-replacement-vizag.jpg

Cemented fixation technique in THR(2)• Cemented fixation uses an acrylic

polymer (PMMA) • Both the bone and the cement must

lock together in order to make the insertion last. • Bone cement is not glue and it doesn’t

stick to anything. • Cement simply acts as a filler between

the bone and the implant.

http://www.eorthopod.com/images/ContentImages/hip/hip_arthroplasty/hip_arthroplasty_cemented01.jpg

1 http://bonesmart.org/hip/types-of-total-hip-implants/

Uncemented fixation

• Stems are rough (tetanum, cobalt-chromium alloy)

• Cups are made from metal alloy with rough outer part

• Cementless implants are covered with porous or hydroxyapatite covering• The maximum bone

ingrowth capability is obtained with the pore size 100–200 µm

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2779384/

http://eorthopod.com/hip-replacement/

Uncemented fixation

technique in THR

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2779384/ http://www.healthpages.org/surgical-care/hip-joint-replacement-surgery/

Cemented fixation in THR

1. Is more suitable for obese patients

https://www.ncbi.nlm.nih.gov/pubmed/20720138/

http://www.wjgnet.com/2218-5836/full/v5/i5/591.htm

Uncemented fixation in THR

1. Revision rate is lower within ten years after operation

Cemented fixation in THR

2. Has a better outcome in case of

displastic hip

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662257/

Uncemented fixation in THR

https://www.ncbi.nlm.nih.gov/pubmed/3818732

2. Risk for femoral loosening is low

It has been implied that once stable fixation occurs in the cementless implant, it does not deteriorate with time.

Cemented fixation in THR3. Is better for the patients with osteoporosis

https://www.ncbi.nlm.nih.gov/pubmed/25850905

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662257/

Uncemented fixation in THR

3. Osteolysis is not common

Cemented fixation in THR

4. Has a lower risk for intra-operative femur

fractures

https://www.ncbi.nlm.nih.gov/pubmed/27037428

https://www.ncbi.nlm.nih.gov/pubmed/12647048

Uncemented fixation in

THR

4. The incidence of fat embolism during the operation is much lower

Cemented fixation in THR5. Is cheaper than the cementless THR

http://www.amc.lv/index.php?p=6336&lang=634&pp=10469https://www.ncbi.nlm.nih.gov/pubmed/26561859

http://bja.oxfordjournals.org/content/102/1/12.full

Uncemented fixation in THR

5. During the process of cement polimerisation Bone Cement Implantation Syndrome (BCIS) may develop. The uncemented fixation

is free of this complication.

BCIS is characterized by hypoxia, hypotension or both and/or unexpected loss of consciousness in a patient undergoing cemented bone surgery.

Conclusions

• No significant differences between cemented and cementless group in terms of implant survival, patient mortality or the complication rate exist

• Each of these methods should be applied for every patient individual needs

Thank you for your attention!

Discussion