Concrete Benefits Found With Cementless Hip Replacement
March 16, 2000 (Orlando, Fla.) -- Cementless hip replacements appear to
stand up well in both young and old patients, said surgeons in a series of
reports at a meeting of orthopaedic surgeons here. In long-term follow-up
studies, a majority of patients who received the devices have stable, pain-free
implants, some for as long as 15 years.
Patients getting a hip replacement typically get the leg portion of the
artificial hip fixed into their thighbone using a type of cement. Early
experiments where surgeons tried to fix devices without cement had many
problems -- primarily because the devices became loose. Most surgeons in the
U.S. abandoned the cementless approach, though there was an understanding that
these devices may last much longer if they could be fitted properly.
Typical implants need to be replaced after 10-15 years, so a lifelong
implant would be of particular interest to patients in their forties and
"Personally -- and this is not an emotional statement but is based on
our data and on the outcomes we have with fixation of cementless implants -- I
believe cementless implants can last the patient forever, no matter what age
they're put in," says Lawrence D. Dorr, MD, in an interview with WebMD.
Dorr, a pioneer of cementless surgery who was not involved in the studies
reported here, is director of the Bone and Joint Institute at Good Samaritan
Hospital in Los Angeles.
Younger patients, who tend to be a lot tougher on their hips than seniors
and can reasonably expect to outlive the implant, appear to be good candidates
for cementless devices, reports Wayne G. Paprosky, MD, associate professor of
orthopaedics at Rush Medical College in Chicago. In a study of 95 patients
younger than 50 who received cementless implants and were followed for 12-16
years, nearly 96% had good bone ingrowth. Ingrowth is important because it
shows that the bone has grown around the implant and it is much more likely to
be stable and permanent. Only two of the 95 hips required more surgery, and
only one showed evidence of loosening.
However, older patients can get in on the act as well. A second study
suggests that even patients as old as 90 can benefit from cementless hip
replacement, in contrast to earlier concerns about poor fixation, pain, and
cost, say William J. Hozack, MD, and colleagues from the Rothman Institute at
Thomas Jefferson University in Philadelphia.
For 11 years, they followed almost 150 patients 80-90 years old who
underwent their first total hip replacement with the cementless devices. About
19% of patients had early medical complications from the surgery, but there
were no deaths while the patients were in the hospital and no complications
such as fractures, dislocations, infections, or large blood clots, the
researchers say. The thigh and hip components of all implants appeared to be
stable, and in 96% of patients there was evidence of bone ingrowth.
"Results equaled that of [the traditional cemented hip replacement].
With ever-increasing life expectancy and activity of the elderly, arbitrary age
criteria for implant selection are inappropriate and cementless [hip
replacement] is a reasonable choice," says Hozack, who is professor of
orthopaedics at the Rothman Institute.