Houston Methodist. Leading Medicine

Hip FAQ

Question:

I'm checking into hip replacements -- type of material, design, arthroscopic versus open surgery, minimally invasive versus mini-incision. You name it, I'm checking it out. What can you tell me about the durability of the cemented versus cementless implant. Does one last longer than the other? I want something that will last me a good long time -- maybe even the rest of my life.

Answer:

As you have discovered, when joint replacements are put in place, they can be cemented in place or the surgeon can use a cementless type that fills in with bone. Both are still commonly in use but many surgeons have switched to all cementless. They made this switch to avoid implant loosening, which is more common with cemented implants. Loosening aside, the question of whether cemented survive longer (and better) than cementless has come up many times. We found a big study looking at all the published articles (called a systematic review) combining data from many smaller studies, (called a meta-analysis) may provide some answers. Researchers from the Rothman Institute of Orthopedics at Thomas Jefferson University Hospital in Philadelphia took the time to examine the literature and analyze the combined results. Out of 3,488 potential articles, 81 met the necessary criteria to be included. About half (45) were studies on the long-term results using cementless acetabular (hip socket) components. One-third (29) reported the long-term outcomes of cemented acetabular parts. And the rest (7) compared the two together. All acetabular implants were made of polyethylene (a type of plastic). Although this study only looked at cemented versus cementless implants, it is clear that whether or not a component part survives (and how long it holds up) isn't only dependent on the cemented versus cementless factor. There are other variables that can affect acetabular survival. Some are based on the component itself such as surface finish, how long the polyethylene itself lasts (i.e., shelf life), and the method of sterilization for the component part. Some are patient-based influences including bone quality, patient activity level, and patient size (body mass index). And there are surgeon-based factors (e.g., level of experience and expertise, type of surgical approach used for the procedure). Very few of the articles of high enough quality to be included adjusted or controlled for these other variables. That is a major limitation in answering the question of how using a cemented versus cementless implant compares when it comes to survivorship. There are just too many other variables that could be making the difference. With that fact in mind, you will want to know there were no major differences observed in revision rate between these two types of implants (based on the cement versus no-cement factor). And revisions because of aseptic (without infection) loosening were equal between the two groups. However, more cemented acetabular components were still in place 10 years or more after implantation indicating longer survivorship of the cemented cup. Age may be something important to consider. When comparing revision rate between cemented and cementless cups, they found an interesting phenomenon. Younger patients did better with uncemented cups. Older patients had better results with the cemented cups. The results of this systematic review and meta-analysis suggest that despite improvements in cementless implants, their durability and survivorship doesn't match cemented implants. Thus, the literature does not yet prove the superiority of the cementless acetabular component over the cemented type. Nader Toossi, MD, et al. Acetabular Components in Total Hip Arthroplasty: Is There Evidence That Cementless Fixation is Better? In The Journal of Bone and Joint Surgery. January 16, 2013. Vol. 95A. No. 2. Pp. 168-174.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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