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Similar early mortality risk after cemented compared with cementless total hip arthroplasty for primary osteoarthritis: data from 188,606 surgeries in the Nordic Arthroplasty Register Association database

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  • Alma B. Pedersen
  • Aurélie Mailhac
  • Anne Garland, Uppsala University, Registercentrum Västra Götaland
  • ,
  • Søren Overgaard, Department of Orthopedic Surgery and Traumatology, University of Southern Denmark
  • ,
  • Ove Furnes, University of Bergen
  • ,
  • Stein Atle Lie, University of Bergen
  • ,
  • Anne Marie Fenstad, University of Bergen
  • ,
  • Cecilia Rogmark, Lund University, Registercentrum Västra Götaland
  • ,
  • Johan Kärrholm, Registercentrum Västra Götaland, University of Gothenburg
  • ,
  • Ola Rolfson, Registercentrum Västra Götaland, University of Gothenburg
  • ,
  • Jaason Haapakoski, National Institute for Health and Welfare
  • ,
  • Antti Eskelinen, National Institute for Health and Welfare, Tampere University
  • ,
  • Keijo T. Mäkelä, National Institute for Health and Welfare, University of Turku
  • ,
  • Nils P. Hailer, Uppsala University, Registercentrum Västra Götaland

Background and purpose — Current literature indicates no difference in 90-day mortality after cemented compared with cementless total hip arthroplasty (THA). However, previous studies are hampered by potential selection bias and suboptimal adjustment for comorbidity confounding. Therefore, we examined the comorbidity-adjusted mortality up to 90 days after cemented compared with cementless THA performed due to osteoarthritis. Patients and methods — Using the Nordic Arthroplasty Register Association database, 2005–2013, we included 108,572 cemented and 80,034 cementless THA due to osteoarthritis. We calculated the Charlson comorbidity index of each patient based on data from national patient registers. The Kaplan–Meier method was used to estimate unadjusted all-cause mortality. Cox regression was used to estimate hazard ratios (HR) with 95% confidence intervals (CI) for 14, 30-, and 90-day mortality comparing cemented with cementless THA, adjusting for age, sex, comorbidity, nation, and year of surgery. Results — Cumulative all-cause mortality within 90 days was 0.41% (CI 0.37–0.46) after cemented and 0.26% (CI 0.22–0.30) after cementless THA. The adjusted HR for cemented vs. cementless fixation was 0.97 (CI 0.79–1.2), and similar risk estimates were obtained for mortality within 14 (adjusted HR 0.91 [CI 0.64–1.3]) and 30 days (adjusted HR 0.94 [CI 0.71–1.3]). We found no clinically relevant differences in mortality between cemented and cementless THA in analyses stratified by age, sex, Charlson comorbidity index, or year of surgery. Interpretation — After adjustment for comorbidity as an important confounder, we observed similar early mortality between the 2 fixation techniques.

Original languageEnglish
JournalActa Orthopaedica
ISSN1745-3674
DOIs
Publication statusE-pub ahead of print - Nov 2020

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