Chen Xiao T, Christ Alexander B, Chung Brian C, Ton Andy, Ballatori Alexander M, Shahrestani Shane, Gettleman Brandon S, Heckmann Nathanael D
Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 91803, USA.
University of South Carolina School of Medicine, Columbia, SC 29209, USA.
J Clin Med. 2023 Jun 9;12(12):3945. doi: 10.3390/jcm12123945.
Cementless fixation during total hip arthroplasty (THA) is the predominant mode of fixation utilized for both acetabular and femoral components during elective primary THAs performed in the United States. This study aims to compare early complication and readmission rates between primary THA patients receiving cemented versus cementless femoral fixation. The 2016-2017 National Readmissions Database was queried to identify patients undergoing elective primary THA. Postoperative complication and readmission rates at 30, 90, and 180 days were compared between cemented and cementless cohorts. Univariate analysis was conducted to compare differences between cohorts. Multivariate analysis was performed to account for confounding variables. Of 447,902 patients, 35,226 (7.9%) received cemented femoral fixation, while 412,676 (92.1%) did not. The cemented group was older (70.0 vs. 64.8, < 0.001), more female (65.0% vs. 54.3%, < 0.001), and more comorbid (CCI 3.65 vs. 3.22, < 0.001) compared to the cementless group. On univariate analysis, the cemented cohort had decreased odds of periprosthetic fracture at 30 days postoperatively (OR: 0.556, 95%-CI 0.424-0.729, < 0.0001), but higher odds of hip dislocation, periprosthetic joint infection, aseptic loosening, wound dehiscence, readmission, medical complications, and death at all timepoints. On multivariate analysis, the cemented fixation cohort demonstrated reduced odds of periprosthetic fracture at all postoperative timepoints: 30 (OR: 0.350, 95%-CI 0.233-0.506, < 0.0001), 90 (OR: 0.544, 95%-CI 0.400-0.725, < 0.0001), and 180 days (OR: 0.573, 95%-CI 0.396-0.803, = 0.002). Cemented femoral fixation was associated with significantly fewer short-term periprosthetic fractures, but more unplanned readmissions, deaths, and postoperative complications compared to cementless femoral fixation in patients undergoing elective THA.
在美国进行的择期初次全髋关节置换术（THA）中，非骨水泥固定是髋臼和股骨组件使用的主要固定方式。本研究旨在比较接受骨水泥型与非骨水泥型股骨固定的初次THA患者的早期并发症和再入院率。查询2016 - 2017年国家再入院数据库以识别接受择期初次THA的患者。比较骨水泥型和非骨水泥型队列在术后30天、90天和180天的并发症和再入院率。进行单因素分析以比较队列之间的差异。进行多因素分析以考虑混杂变量。在447,902例患者中，35,226例（7.9%）接受了骨水泥型股骨固定，而412,676例（92.1%）未接受。与非骨水泥型组相比，骨水泥型组年龄更大（70.0岁对64.8岁，<0.001），女性更多（65.0%对54.3%，<0.001），合并症更多（CCI 3.65对3.22，<0.001）。单因素分析显示，骨水泥型队列术后30天假体周围骨折的几率降低（OR：0.556，95%CI 0.424 - 0.729，<0.0001），但在所有时间点髋关节脱位、假体周围关节感染、无菌性松动、伤口裂开、再入院、医疗并发症和死亡的几率更高。多因素分析显示，骨水泥固定队列在所有术后时间点假体周围骨折的几率均降低：30天（OR：0.350，95%CI 0.233 - 0.506，<0.0001）、90天（OR：0.544，95%CI 0.400 - 0.725，<0.0001）和180天（OR：0.573，95%CI 0.396 - 0.803，=0.002）。在接受择期THA的患者中，与非骨水泥型股骨固定相比，骨水泥型股骨固定与短期假体周围骨折显著减少相关，但计划外再入院、死亡和术后并发症更多。
