Archives of Orthopaedic and Trauma Surgery - 2026-05-02 - Journal Article
Cemented total hip arthroplasty reduces early complications: a Japanese nationwide propensity-matched study.
Tanaka H, Tarasawa K, Mori Y, Baba K, Kurishima H, Fushimi K, Aizawa T, Fujimori K
Topics
Key Takeaway
Cemented THA reduced periprosthetic fracture risk by 60% (OR 0.40) and transfusion need by 24% (OR 0.76) versus uncemented fixation in propensity-matched elderly Japanese patients.
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Summary
This study compared early postoperative complications between cemented and uncemented primary THA in patients ≥65 years using the Japanese DPC nationwide database (2011–2023). After propensity score matching on age, sex, BMI, and Charlson Comorbidity Index, cemented fixation demonstrated significantly lower rates of periprosthetic fracture (OR 0.40), transfusion (OR 0.76), and DVT (OR 0.79). No significant differences were found in dislocation, infection, pulmonary embolism, cardiac or cerebrovascular events, or in-hospital mortality, though a non-significant trend toward higher in-hospital mortality in the cemented group was noted.
Key Limitation
In-hospital-only follow-up precludes assessment of cement-related cardiovascular events (bone cement implantation syndrome mortality), aseptic loosening, and late periprosthetic fractures, which are the primary long-term concerns driving preference for uncemented fixation.
Original Abstract
INTRODUCTION
The optimal fixation method in total hip arthroplasty (THA) remains under debate. While cemented fixation has been associated with a lower risk of periprosthetic fracture, uncemented fixation predominates in Japan. This study aimed to compare early postoperative complications between cemented and uncemented fixation in elective THA using a nationwide inpatient database.
MATERIALS AND METHODS
We identified 198,102 patients aged ≥ 65 years who underwent primary THA for osteoarthritis, osteonecrosis, or rheumatoid arthritis between December 2011 and March 2023 from the Japanese Diagnosis Procedure Combination (DPC) database. After 1:1 propensity score matching for age, sex, body mass index (BMI), and Charlson Comorbidity Index, 36,859 patients were included in each fixation cohort. Surgical and medical complications, and in-hospital mortality were compared using multivariate logistic regression.
RESULTS
Cemented fixation was associated with a significantly lower risk of periprosthetic fracture (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.30-0.53; p < 0.001), blood transfusion (OR, 0.76; 95% CI, 0.74-0.78; p < 0.001), and deep vein thrombosis (OR, 0.79; 95% CI, 0.74-0.84; p < 0.001). There were no statistically significant differences based on the predefined threshold (p < 0.001) in dislocation, infection, pulmonary embolism, cardiac or cerebrovascular events, or in-hospital mortality between fixation types, although a trend toward higher in-hospital mortality in the cemented group was observed.
CONCLUSIONS
Cemented THA was associated with reduced rates of periprosthetic fracture, transfusion, and deep vein thrombosis without increasing other perioperative or medical complications. These findings suggest that cemented fixation may be associated with favorable short-term outcomes in selected patients.