Commentary

What is wrong with the cemented total hip?

Per Kjaersgaard-Andersen, MD
Per Kjaersgaard-Andersen

A paradox is taking place among hip replacement surgeons worldwide: Cemented total hip replacements have significantly lower rates of revision for any reason compared with cementless total hip replacements, both in men and women, young and old. This has been clear from the Scandinavian registers for years, and newly published data from the National Joint Registry for England and Wales has provided further evidence. However, these same registries also show that each year, the use of cementless implants continues to increase, with many European countries now implanting cementless hips more frequently than cemented.

A summary of the National Joint Registry for England and Wales 7th Annual Report was published in the November/December 2010 issue of Orthopaedics Today Europe and on the ORTHOSuperSite. Despite being published toward the end of the year, the article received more hits than any other Orthopaedics Today Europe article published in 2010, showing that our readers did find their observation interesting and important (see Orthopaedics Today Europe's top five articles from 2010).

For several reasons, we should mainly use cemented total hip replacement (THR) implants — not only because they have a better survival than the existing cementless and large-head metal-on-metal implants, but also because they are the best-proven implants and are all significantly less costly.

I have yet to hear a reasonable explanation of the paradox, or an acceptable answer to the question: Why is the use of cementless THR still increasing, despite evidence of better results with cement?

Many speculations have been made. Perhaps it is more demanding to perform a perfect cemented THR than a cementless THR, making the latter more frequently selected as the surgeon’s primary choice. Or maybe it is because of the extra time needed to mix and implant the cement, as well as the time it takes for the cement to harden before surgery can continue — decreasing the possible number of procedures performed per day when compared to that of cementless THRs. There is also the possibility that industry plays some role in this trend by mainly focusing on newer cementless implants.

We as hip surgeons need to start a discussion on how to ensure that the paradoxical trend towards more cementless THRs can be reversed, making sure that cemented THR — the best proven and significantly less frequently revised implant —is still available to our patients in the coming years. If this turn does not take place, we will face clinics within a few years where no surgeons have experience with performing a well-fixed cemented THR.

Per Kjaersgaard-Andersen, MD
Per Kjaersgaard-Andersen

A paradox is taking place among hip replacement surgeons worldwide: Cemented total hip replacements have significantly lower rates of revision for any reason compared with cementless total hip replacements, both in men and women, young and old. This has been clear from the Scandinavian registers for years, and newly published data from the National Joint Registry for England and Wales has provided further evidence. However, these same registries also show that each year, the use of cementless implants continues to increase, with many European countries now implanting cementless hips more frequently than cemented.

A summary of the National Joint Registry for England and Wales 7th Annual Report was published in the November/December 2010 issue of Orthopaedics Today Europe and on the ORTHOSuperSite. Despite being published toward the end of the year, the article received more hits than any other Orthopaedics Today Europe article published in 2010, showing that our readers did find their observation interesting and important (see Orthopaedics Today Europe's top five articles from 2010).

For several reasons, we should mainly use cemented total hip replacement (THR) implants — not only because they have a better survival than the existing cementless and large-head metal-on-metal implants, but also because they are the best-proven implants and are all significantly less costly.

I have yet to hear a reasonable explanation of the paradox, or an acceptable answer to the question: Why is the use of cementless THR still increasing, despite evidence of better results with cement?

Many speculations have been made. Perhaps it is more demanding to perform a perfect cemented THR than a cementless THR, making the latter more frequently selected as the surgeon’s primary choice. Or maybe it is because of the extra time needed to mix and implant the cement, as well as the time it takes for the cement to harden before surgery can continue — decreasing the possible number of procedures performed per day when compared to that of cementless THRs. There is also the possibility that industry plays some role in this trend by mainly focusing on newer cementless implants.

We as hip surgeons need to start a discussion on how to ensure that the paradoxical trend towards more cementless THRs can be reversed, making sure that cemented THR — the best proven and significantly less frequently revised implant —is still available to our patients in the coming years. If this turn does not take place, we will face clinics within a few years where no surgeons have experience with performing a well-fixed cemented THR.