Similar early mortality risk after cemented compared with cementless total hip arthroplasty for primary osteoarthritis: data from 188,606 surgeries in the Nordic Arthroplasty Register Association database

Alma B  Pedersen; Aurélie Mailhac; Anne Garland; Søren Overgaard; Ove Furnes; Stein Atle Lie; Anne Marie Fenstad; Cecilia Rogmark; Johan Kärrholm; Ola  Rolfson; Jaason Haapakoski; Antti Eskelinen; Keijo T Mäkelä; Nils P Hailer

doi:10.1080/17453674.2020.1842003

Authors

Alma B Pedersen Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
Aurélie Mailhac Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
Anne Garland Department of Surgical Sciences/Orthopedics, Uppsala University, Uppsala, Sweden; The Swedish Hip Arthroplasty Registry, Registercentrum Västra Götaland, Gothenburg, Sweden
Søren Overgaard Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense, Denmark, and the Danish Hip Arthroplasty Register
Ove Furnes The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Norway
Stein Atle Lie Department of Clinical Medicine, University of Bergen, Norway; Department of Clinical Dentistry, University of Bergen, Bergen, Norway
Anne Marie Fenstad The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
Cecilia Rogmark Department of Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden; The Swedish Hip Arthroplasty Registry, Registercentrum Västra Götaland, Gothenburg, Sweden
Johan Kärrholm The Swedish Hip Arthroplasty Registry, Registercentrum Västra Götaland, Gothenburg, Sweden; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
Ola Rolfson The Swedish Hip Arthroplasty Registry, Registercentrum Västra Götaland, Gothenburg, Sweden; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
Jaason Haapakoski Finnish Arthroplasty Register, National Institute for Health and Welfare, Helsinki, Finland
Antti Eskelinen Finnish Arthroplasty Register, National Institute for Health and Welfare, Helsinki, Finland; Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, University of Tampere, Tampere, Finland
Keijo T Mäkelä Finnish Arthroplasty Register, National Institute for Health and Welfare, Helsinki, Finland; Department of Orthopedics and Traumatology, Turku University Hospital, Turku, Finland
Nils P Hailer Department of Surgical Sciences/Orthopedics, Uppsala University, Uppsala, Sweden; The Swedish Hip Arthroplasty Registry, Registercentrum Västra Götaland, Gothenburg, Sweden

DOI:

https://doi.org/10.1080/17453674.2020.1842003

Abstract

Background and purpose — Current literature indicates no difference in 90-day mortality after cemented compared with cementless total hip arthroplasty (THA). However, previous studies are hampered by potential selection bias and suboptimal adjustment for comorbidity confounding. Therefore, we examined the comorbidity-adjusted mortality up to 90 days after cemented compared with cementless THA performed due to osteoarthritis.

Patients and methods — Using the Nordic Arthroplasty Register Association database, 2005–2013, we included 108,572 cemented and 80,034 cementless THA due to osteoarthritis. We calculated the Charlson comorbidity index of each patient based on data from national patient registers. The Kaplan–Meier method was used to estimate unadjusted all-cause mortality. Cox regression was used to estimate hazard ratios (HR) with 95% confidence intervals (CI) for 14 , 30-, and 90-day mortality comparing cemented with cementless THA, adjusting for age, sex, comorbidity, nation, and year of surgery.

Results — Cumulative all-cause mortality within 90 days was 0.41% (CI 0.37–0.46) after cemented and 0.26% (CI 0.22–0.30) after cementless THA. The adjusted HR for cemented vs. cementless fixation was 0.97 (CI 0.79–1.2), and similar risk estimates were obtained for mortality within 14 (adjusted HR 0.91 [CI 0.64–1.3]) and 30 days (adjusted HR 0.94 [CI 0.71–1.3]). We found no clinically relevant differences in mortality between cemented and cementless THA in analyses stratified by age, sex, Charlson comorbidity index, or year of surgery.

Interpretation — After adjustment for comorbidity as an important confounder, we observed similar early mortality between the 2 fixation techniques.