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Cemented Versus Cementless Total Hip Replacements in Patients Fifty-five Years of Age or Older with Rheumatoid Arthritis
Keijo T. Mäkelä, MD, PhD1; Antti Eskelinen, MD, PhD2; Pekka Pulkkinen, PhD3; Petri Virolainen, MD, PhD1; Pekka Paavolainen, MD, PhD4; Ville Remes, MD, PhD5
1 Department of Orthopaedics and Traumatology, Turku University Central Hospital, Luolavuorentie 2, PL 28, 20701 Turku, Finland. E-mail address for K.T. Mäkelä: keijo.makela@tyks.fi
2 COXA Hospital for Joint Replacement, Tahmelan viertotie 26A, 33250 Tampere, Finland
3 Department of Public Health, University of Helsinki, P.O. Box 41 (Mannerheimintie 172), 00014 Helsinki, Finland
4 ORTON Orthopaedic Hospital, Invalid Foundation, Tenholantie 10, 00280 Helsinki, Finland
5 Department of Orthopaedics and Traumatology, Peijas, Helsinki University Central Hospital, Töölönkatu 31 a 13, 00260 Helsinki, Finland
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Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants of less than $10,000 from the Sigrid Jusélius Foundation. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at Turku University Central Hospital, Turku, COXA Hospital for Joint Replacement, Tampere, Helsinki University Central Hospital, Helsinki, University of Helsinki, Helsinki, and ORTON Orthopaedic Hospital, Helsinki, Finland

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Jan 19;93(2):178-186. doi: 10.2106/JBJS.I.01283
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Abstract

Background: 

Results obtained from single-center studies indicate that a cemented total hip replacement is the treatment of choice for the management of patients over fifty-five years of age with rheumatoid arthritis. The aim of this study was to analyze population-based survival rates for cemented and cementless total hip replacements in patients aged fifty-five years or over with rheumatoid arthritis in Finland.

Methods: 

Between 1980 and 2006, a total of 6000 primary total hip replacements performed for the management of rheumatoid arthritis in patients who were fifty-five years of age or older were entered in the Finnish Arthroplasty Registry. 4019 of them fulfilled our inclusion criteria and were subjected to analysis. The implants were classified into one of three possible groups: (1) a cementless group (a noncemented proximally porous-coated stem and a noncemented porous-coated press-fit cup), (2) a cemented group 1 (a cemented, loaded-taper stem combined with a cemented, all-polyethylene cup), or (3) a cemented group 2 (a cemented, composite-beam stem with a cemented, all-polyethylene cup).

Results: 

Cementless stems and cups, analyzed separately, had a significantly lower risk of revision for aseptic loosening than cemented implants in patients who were fifty-five years of age or older with rheumatoid arthritis. The fifteen-year survival rate of cementless total hip replacements (80%) was comparable with the rates of the cemented groups (86% in cemented group 1 and 79% in cemented group 2) when revisions for any reason were used as the end point.

Conclusions: 

Cementless and cemented total hip replacements produced comparable long-term results in patients who were fifty-five years of age or older with rheumatoid arthritis.

Level of Evidence: 

Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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