Uncemented and cemented primary total hip arthroplasty in the Swedish Hip Arthroplasty Register

Figures & data

Table 1.  Patient demographics

	n	%
Sex
Male	56,532	39
Female	88,805	61
Age (years)
0–49	5,182	4
50–59	16,182	11
60–75	74,950	52
> 75	49,025	34
Primary diagnosis
Primary OA	110,438	76
Inflammatory disease	5,397	4
Fracture	18,832	13
Pediatric hip disease	2,073	1
Idiopathic femoral head necrosis	4,430	3
Secondary posttraumatic OA	371	0.3
Others		1

Table 2.  The 10 most common implants

	n	%
A)	The 10 most common cemented cups
Lubinus	62,044	38
Charnley	28,386	18
Exeter Duration	11,938	7
Charnley Elite	11,351	7
Reflection	8,351	5
Exeter Plast	6,668	4
FAL	4,513	3
Biomet Müller	4,099	3
Scan Hip Cup	3,937	2
OPTICUP	3,779	2
Other		2
B)	The 10 most common cemented stems
Lubinus SP II	69,991	43
Exeter Polished	33,347	21
Charnley	23,649	15
Spectron EF Primary	8,093	5
Scan Hip Collar	2,989	2
Charnley Elite Plus	2,716	2
Scan Hip II Collar	2,229	1
Müller Straight Stem	2,165	1
Bi-Metric cemented	1,529	1
MS30 Polished	1,509	1
Other		8
C)	The 10 most common uncemented cups
Trilogy HA	1,856	21
CLS Spotorno	1,026	12
Trilogy	868	10
Trident HA	770	9
Allofit	725	8
ABG II HA	433	5
Romanus	405	5
Romanus HA	351	4
Omnifit	325	4
ABG HA	287	3
Other		21
D)	The 10 most common uncemented stems
CLS Spotorno	3,572	40
Bi-Metric HA uncemented	729	8
ABG uncemented	492	6
Omnifit	482	5
Wagner Cone Prosthesis	370	4
Accolade	369	4
Bi-Metric uncemented	334	4
ABG II HA	313	4
Bi-Metric lateral	287	3
Versys	263	3
Other		20

Kaplan-Meier analysis of survival of cemented and uncemented THA. Revision-free survival was significantly lower for uncemented THA than for cemented THA with revision of any component for any reason as endpoint. Bold lines: survival: thin lines: upper and lower limits of 95% confidence intervals. 10-year-survival: 85% (CI: 84–87) for uncemented THA vs. 94% (CI: 93.8–94.2) for cemented THA (p < 0.05, log-rank test). 15-year-survival: 70% (CI: 67–73; 245 THAs at risk) for uncemented THA vs. 88% (CI: 88–89; 3,147 THAs at risk) for cemented THA (p < 0.05, log-rank test).

Table 3.  Cox regression model with relative risk (RR) of revision for any reason.The covariates type of fixation, sex, age, and underlying diagnosis were mutually adjusted for each other. Revision means revision of either cup or stem, or both

	Adjusted RR	CI	p-value
Type of fixation
Cemented ^a	1
Uncemented	1.5	(1.4 –1.6)	< 0.001
Sex
Male ^a	1
Female	0.7	(0.6 –0.7)	< 0.001
Age
< 50 ^a	1
50–59	0.8	(0.7 –0.9)	< 0.001
60–75	0.5	(0.5 –0.6)	< 0.001
> 75	0.4	(0.4 –0.4)	< 0.001
Diagnosis
Primary OA ^a	1
RA	1.2	(1.1 –1.4)	< 0.001
Fracture	1.9	(1.7 –2.0)	< 0.001
Pediatric	1.6	(1.4 –1.8)	< 0.001
Osteonecrosis	1.5	(1.3 –1.7)	< 0.001
Posttraumatic OA	2.1	(1.6 –2.8)	< 0.001
Tumor	2.3	(1.5 –3.5)	< 0.001
Other secondary arthrosis	1.0	(0.7 –1.3)	0.7

^a Reference group that other categories are compared to

Table 4.  Cox regression model with relative risk (RR) of revision due to aseptic loosening. The covariates type of fixation, sex, age, and underlying diagnosis were mutually adjusted for each other. Revision means revision of either cup or stem, or both

	Adjusted RR	CI	p-value
Type of fixation
Cemented ^a	1
Uncemented	1.5	(1.3 –1.6)	< 0.001
Sex
Male ^a	1
Female	0.7	0.6 –0.7)	< 0.001
Age
< 50 ^a	1
50–59	0.7	(0.6 –0.8)	< 0.001
60–75	0.4	(0.4 –0.5)	< 0.001
> 75	0.2	(0.2 –0.2)	< 0.001
Diagnosis
Primary OA ^a	1
RA	1.1	(1.0 –1.2)	0.2
Fracture	1.2	(1.1 –1.4)	0.02
Pediatric	1.5	(1.3 –1.8)	< 0.001
Osteonecrosis	1.3	(1.1 –1.5)	0.01
Posttraumatic OA	1.5	(1.0 –2.2)	0.05
Tumor	1.4	(0.5 –3.7)	0.5
Other secondary arthrosis	0.7	(0.4 –1.0)	0.03

^a Reference group that other categories are compared to

Table 5.  Cox regression model with relative risk (RR) of revision due to infection. The covariates type of fixation, sex, age, and underlying diagnosis were mutually adjusted for each other. Revision means revision of either cup or stem, or both

	Adjusted RR	CI	p-value
Type of fixation
Cemented ^a	1
Uncemented	0.9	(0.6 –1.3)	0.5
Sex
Male ^a	1
Female	0.5	(0.4 –0.5)	< 0.001
Age
< 50 ^a	1
50–59	0.8	(0.6 –1.2)	0.4
60–75	0.7	(0.5 –1.1)	0.1
> 75	0.7	(0.5 –1.0)	0.07
Diagnosis
Primary OA ^a	1
RA	1.4	(1.0 –1.9)	0.04
Fracture	1.8	(1.4 –2.2)	< 0.001
Pediatric	1.2	(0.7 –2.0)	0.6
Osteonecrosis	1.4	(0.9 –2.0)	0.1
Posttraumatic OA	0.5	(0.1 –3.6)	0.5
Tumor	1.7	(0.5 –5.3)	0.4
Other secondary arthrosis	1.1	(0.5 –2.5)	0.8

^aReference group that other categories are compared to.

Table 6.  Summary of adjusted risk ratios. Revision during the entire study period

Endpoint	Population investigated	Reference population	Adjusted RR (CI)	p-value
Revision of any component
for any reason	All uncemented implants	All cemented implants	1.5 (1.4–1.6)	< 0.001
due to aseptic loosening	All uncemented implants	All cemented implants	1.5 (1.3–1.6)	< 0.001
due to deep infection	All uncemented implants	All cemented implants	0.9 (0.6–1.3)	0.5
for any reason	All uncemented implants from 2000	All cemented implants from 2000	1.5 (1.2–1.8)	< 0.001
Cup revision due to aseptic loosening	All uncemented cups	All cemented cups	1.8 (1.6–2.0)	< 0.001
Stem revision due to aseptic loosening	All uncemented stems	All cemented stems	0.4 (0.3–0.5)	< 0.001
Revision for any reason within 2 years
of the index procedure	All uncemented implants	All cemented implants	1.8 (1.5–2.2)	< 0.001
Stem revision due to fracture within 2 years of the index procedure	All uncemented stems	All cemented stems	8.0 (4.5–14)	< 0.001
Cup revision for any reason	5 most common uncemented cups	5 most common cemented cups	0.9 (0.6–1.1)	0.2
Cup revision due to aseptic loosening	5 most common uncemented cups	5 most common cemented cups	0.5 (0.3–0.8)	0.001
Stem revision for any reason	5 most common uncemented stems	5 most common cemented stems	0.5 (0.4–0.6)	< 0.001
Stem revision due to aseptic loosening	5 most common uncemented stems	5 most common cemented stems	0.3 (0.2–0.4)	< 0.001