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Concrete Benefits Found With Cementless Hip Replacement

WebMD Health News

March 16, 2000 (Orlando, Fla.) -- Cementless hip replacements appear to stand up well in both young and old patients, said surgeons in a series of reports at a meeting of orthopaedic surgeons here. In long-term follow-up studies, a majority of patients who received the devices have stable, pain-free implants, some for as long as 15 years.

Patients getting a hip replacement typically get the leg portion of the artificial hip fixed into their thighbone using a type of cement. Early experiments where surgeons tried to fix devices without cement had many problems -- primarily because the devices became loose. Most surgeons in the U.S. abandoned the cementless approach, though there was an understanding that these devices may last much longer if they could be fitted properly.

Typical implants need to be replaced after 10-15 years, so a lifelong implant would be of particular interest to patients in their forties and fifties.

"Personally -- and this is not an emotional statement but is based on our data and on the outcomes we have with fixation of cementless implants -- I believe cementless implants can last the patient forever, no matter what age they're put in," says Lawrence D. Dorr, MD, in an interview with WebMD. Dorr, a pioneer of cementless surgery who was not involved in the studies reported here, is director of the Bone and Joint Institute at Good Samaritan Hospital in Los Angeles.

Younger patients, who tend to be a lot tougher on their hips than seniors and can reasonably expect to outlive the implant, appear to be good candidates for cementless devices, reports Wayne G. Paprosky, MD, associate professor of orthopaedics at Rush Medical College in Chicago. In a study of 95 patients younger than 50 who received cementless implants and were followed for 12-16 years, nearly 96% had good bone ingrowth. Ingrowth is important because it shows that the bone has grown around the implant and it is much more likely to be stable and permanent. Only two of the 95 hips required more surgery, and only one showed evidence of loosening.

However, older patients can get in on the act as well. A second study suggests that even patients as old as 90 can benefit from cementless hip replacement, in contrast to earlier concerns about poor fixation, pain, and cost, say William J. Hozack, MD, and colleagues from the Rothman Institute at Thomas Jefferson University in Philadelphia.

For 11 years, they followed almost 150 patients 80-90 years old who underwent their first total hip replacement with the cementless devices. About 19% of patients had early medical complications from the surgery, but there were no deaths while the patients were in the hospital and no complications such as fractures, dislocations, infections, or large blood clots, the researchers say. The thigh and hip components of all implants appeared to be stable, and in 96% of patients there was evidence of bone ingrowth.

"Results equaled that of [the traditional cemented hip replacement]. With ever-increasing life expectancy and activity of the elderly, arbitrary age criteria for implant selection are inappropriate and cementless [hip replacement] is a reasonable choice," says Hozack, who is professor of orthopaedics at the Rothman Institute.

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