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Researchers compare options for prostheses for patients who need hip replacement surgery

Advances in cementing techniques enable orthopedic surgeons to better fill the spaces between hip prosthetic components and surrounding bone during hip replacement surgery. In fact, a growing number of orthopedic surgeons are using cemented femur and uncemented acetabulum hip bones as a hybrid prosthesis for hip replacement surgery.

A new study demonstrated that the hybrid prosthesis cost less and resulted in similar complications and patient functioning compared with a totally uncemented prosthesis. This work was conducted by the University of Maryland Patient Outcomes Research Team (PORT) studying hip fracture management and total hip replacement for osteoarthritis, the hip PORT, which is supported by the Agency for Healthcare Research and Quality (HS06658).

The researchers compared the outcomes of 271 relatively healthy elderly patients (most of whom were white women) with hip osteoarthritis. The patients had received first-time total hip replacement from numerous orthopedic surgeons in 12 Baltimore area hospitals from 1991-1993. Twice as many patients received totally uncemented prostheses compared with those receiving hybrids. After adjustment for other factors, there were no significant differences in the rate of serious and non-serious medical complications between hybrid and uncemented prostheses. There also were no significant differences in measures of pain and functioning at 2, 6, and 12 months after surgery.

However, totally uncemented prostheses were associated with higher costs (mean of $13,038 vs. $10,938 in 1993 dollars) and longer hospital stays (10.1 vs. 7.9 days) than hybrid prostheses. Surgical approach had no significant effect on hospital complication or readmission rates. Although posterior surgeries had a higher rate of postoperative prosthesis dislocation in the hospital than anterolateral surgeries (4 vs. .7 percent), these patients needed much less help walking and had slightly greater pain reduction up to 1 year later.

More details are in "Outcomes of surgical management of total hip replacement in patients aged 65 years and older: Cemented versus cementless femoral components and lateral or anterolateral versus posterior anatomical approach," by Sheryl Zimmerman, Ph.D., William G. Hawkes, Ph.D., James I. Hudson, M.D., and others, in the March/April 2002 Journal of Orthopaedic Research 20, pp. 182-191.

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