Discrepancy and contradiction regarding fixation of hip stems with or without cement: survey among 765 hip arthroplasty specialists

Abstract

Introduction:

The growing use of cementless stems is associated with an increase in implant-related complications. This global survey study investigates which parameters orthopaedic surgeons currently consider for either cemented or cementless stem fixation in primary total hip arthroplasty (THA).

Methods:

A survey regarding current practice patterns was distributed among hip arthroplasty specialists. Key questions concerned: (i) frequency of using cemented/cementless stems; (ii) frequency of using parameters which influence a choice between both; (iii) usage of specific cut-off values for parameters.

Results:

507 (out of 765) respondents, having at least 5 years’ experience and performing at least 50 cases a year, were selected for analysis. Respondents using both fixation techniques (n = 413; 81%) use a cementless stem in 69% and a cemented stem in 31%. The choice is most frequently based on: (i) patient age; (ii) cortical thickness; (iii) femoral canal shape; (iv) bone mineral density; and (v) stem fit on preoperative templating. 57% using both fixation techniques do not use a specific cut-off value for age. 92% of the respondents that do use a cut-off value for age use exclusively cemented stems in patients being ⩾72.7 years (median 75; range 50–90 years). Considerable discrepancy and even contradictory responses were present regarding the other parameters and the use of specific cut-off values.

Conclusions:

Current practice patterns regarding stem fixation in primary THA vary substantially among orthopaedic surgeons. Evidence-based guidelines are needed to define which parameters and threshold values support the best individual choice for hip stem fixation.

Keywords

Cemented hip stem cementless hip stem implant selection surgical decision making total hip arthroplasty

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