Comparative Analysis of Cemented vs Press-fit Fixation in Total Hip Arthroplasty

Abstract

Research Question: In patients undergoing hip arthroplasty, does the restricted access of the Direct Anterior (DA) approach negatively impact the cementing technique compared to cemented arthroplasty with press-fit fixation, and does this cementing technique decrease the occurrence of loosening and fractures when compared to press-fit fixation utilizing the same surgical approach?

Background and Significance: The purpose of this study was to use a combination of the direct anterior (DA) approach and the cemented replacement technique to achieve the functional benefits of the DA approach as well as the fixation benefits of cemented replacement. The limited access to the hip of the DA approach may have a negative impact on the cement technique. Additionally, does the use of such a cementing technique minimize the proportion of patients who experience difficulties that are not caused by cement?

Materials and Methods: We conducted a retrospective analysis of 341 patients (360 hips) who underwent the DA total hip arthroplasty (THA) approach between 2016 and 2018. The total number of press-fit stems was 203, while the number of cemented stems was 157. The average age in the press-fit group was 75 years (ranging from 70 to 86), while in the cemented group it was 76 years (ranging from 52 to 94). Of the 341 patients, 239 individuals (70%) were females. The occurrence of femoral complications was compared between the two groups. The average duration of follow-up was 1.5 years (ranging from 0.1 to 4.4 years) for patients in the press-fit group, and 1.3 years (ranging from 0.0 to 3.9 years) for patients in the cemented group.

Results: The press-fit group had a greater incidence of complications related to the femur (8 vs 0; p = 0.011). There were a total of two stems with failure of fixation and six instances of bone fractures, all of which necessitated further examination and correction. Fractures were observed at an average of 14.5 days (ranging from 2 to 31) after the surgery, while loosening occurred at 189 and 422 days after the surgery. The femoral cementing procedure can be safely performed using the DA approach, resulting in a lower incidence of complications compared to a contemporary series that does not involve the use of cement.

Conclusion: Press-fit stems exhibited a greater incidence of early fractures and loosening. A similar rate of complication was not observed in our group of patients who received cemented stems. The process of cementing was successfully carried out using the DA approach without any complications. Femoral cementing during THA using the DA approach does not contribute to surgical intricacy or duration, exhibits fewer initial femoral complications, and represents a safer alternative for elderly patients when compared to press-fit femoral arthroplasties.