Cemented versus uncemented fixation in total hip replacement

Cemented versus uncemented fixation in total hip replacement

1. Debate «FOR/AGAINST» Cemented vs uncemented fixation in total hip replacement Anna Terentjeva RSU MF IV Vlada Meļņikova RSU MF IV Riga, 2016

2. Cemented fixation te c hnique in total hip replacement (THR)(1) http://www.jointreplacementvizag.com/images/home/joint-replacement-services/total-hip-replacement-vizag.jpg

3. Cemented fixation te c hnique in THR(2) Cemented fixation uses an acrylic polymer (PMMA) B oth the bone and the cement must lock together in order to make the insertion last. Bone cement is not glue and it doesn’t stick to anything. Cement simply acts as a filler between the bone and the implant. http://www.eorthopod.com/images/ContentImages/hip/hip_arthroplasty/hip_arthroplasty_cemented01.jpg 1 http://bonesmart.org/hip/types-of-total-hip-implants/

4. Uncemented fixation Stems are rough ( tetanum , cobalt-chromium alloy) Cups are made from metal alloy with rough outer part C ementless implants are covered with porous or hydroxyapatite covering T he maximum bone ingrowth capability is obtained with the pore size 100–200 µm https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2779384/ http://eorthopod.com/hip-replacement /

5. Uncemented fixation technique in THR https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2779384/ http://www.healthpages.org/surgical-care/hip-joint-replacement-surgery /

6. Cemented fixation in THR Is more suitable for obese patients https://www.ncbi.nlm.nih.gov/pubmed/20720138/

7. Uncemented fixation in THR 1 . Revision rate is lower within ten years after operation http://www.wjgnet.com/2218-5836/full/v5/i5/591.htm

8. Cemented fixation in THR Has a better outcome in case of displastic hip https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662257/

9. Uncemented fixation in THR https://www.ncbi.nlm.nih.gov/pubmed/3818732 2 . Risk for femoral loosening is low It has been implied that once stable fixation occurs in the cementless implant, it does not deteriorate with time.

10. Cemented fixation in THR Is better for the patients with osteoporosis https://www.ncbi.nlm.nih.gov/pubmed/25850905

11. Uncemented fixation in THR 3 . Osteolysis is not common https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662257/

12. Cemented fixation in THR Has a lower risk for intra-operative femur fractures https://www.ncbi.nlm.nih.gov/pubmed/27037428

13. Uncemented fixation in THR 4 . The incidence of fat embolism during the operation is much lower https://www.ncbi.nlm.nih.gov/pubmed/12647048

14. Cemented fixation in THR Is cheaper than the cementless THR http://www.amc.lv/index.php?p=6336&lang=634&pp=10469 https://www.ncbi.nlm.nih.gov/pubmed/26561859

15. Uncemented fixation in THR 5 . During the process of cement polimerisation Bone Cement Implantation Syndrome (BCIS) may develop. The uncemented fixation is free of this complication. http://bja.oxfordjournals.org/content/102/1/12.full BCIS is characterized by hypoxia, hypotension or both and/or unexpected loss of consciousness in a patient undergoing cemented bone surgery.

16. Conclusions N o significant differences between cemented and cementless group in terms of implant survival, patient mortality or the complication rate exist Each of these methods should be applied for every patient individual needs

17. Thank you for your attention!

18. Discussion