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Total Hip Arthroplasty for Primary Osteoarthritis in Patients Fifty-five Years of Age or Older

An Analysis of the Finnish Arthroplasty Registry

¹ Rauhankatu 24 D 32, 20100 Turku, Finland. E-mail address: keijo.makela{at}tyks.fi
² Tahmelan viertotie 26A, 33250 Tampere, Finland
³ Department of Public Health, P.O. Box 41 (Mannerheimintie 172), 00014 University of Helsinki, Finland
⁴ Tenholantie 10, 00280 Helsinki, Finland
⁵ Sepänkatu 7A 26, 00150 Helsinki, Finland
Investigation performed at Turku University Central Hospital, Turku, Coxa Hospital for Joint Replacement, Tampere, Helsinki University Central Hospital, Helsinki, University of Helsinki, Helsinki, and Orton Orthopaedic Hospital, Helsinki, Finland

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants of less than $10,000 from Orton Research Institute, Invalid Foundation, Helsinki, Finland. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

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Methods: From 1980 to 2004, a total of 50,968 primary total hip replacements that met our criteria were entered in the Finnish Arthroplasty Registry. The success rate of different implant groups was analyzed. The implants included were classified in one of the following four groups: implants with a cementless, straight, proximally circumferentially porous-coated stem and a modular, porous-coated press-fit cup (cementless group 1); implants with a cementless, anatomic, proximally circumferentially porous-coated and/or hydroxyapatite-coated stem with a modular, porous-coated and/or hydroxyapatite-coated press-fit cup (cementless group 2); a hybrid total hip replacement consisting of a cemented stem combined with a modular, press-fit cup (the hybrid group); and a cemented loaded-taper or composite-beam stem combined with an all-polyethylene cup (the cemented group).

Results: Cementless total hip replacements, as well as cementless stems and cups analyzed separately, had a significantly reduced risk of revision for aseptic loosening compared with cemented hip replacements (p < 0.001). When revision for any reason was the end point in survival analyses, however, there were no significant differences among the groups. In patients between the ages of fifty-five and sixty-four years, the fifteen-year survival rates of the two cementless groups (78% and 80%) were higher than that of the cemented group (71%) with revision for aseptic loosening as the end point. In patients who were sixty-five to seventy-four years old, the fifteen-year survival rate of the implants in cementless group 1 was 94%, while cemented total hip replacements had an 85% survival rate. In patients who were seventy-five years old or more, no significant differences were detected among the total hip replacement groups; all of them had survivorship of >90% at ten years.

Conclusions: In patients who were fifty-five years of age or older, the long-term survival of cementless total hip replacements was comparable with that of cemented replacements. In patients who were fifty-five to seventy-four years old, straight porous-coated cementless stems had better long-term survival than the cemented stems. In patients who were seventy-five years of age and older, there were no significant differences in the results. Multiple wear-related revisions of the cementless cups in the present study indicate that excessive polyethylene wear was a major clinical problem with modular cementless cups in all age groups.

Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

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