Cemented and uncemented total hip arthroplasty each have benefits and drawbacks. Cemented fixation provides a biological bond and is more forgiving of osteoporotic bone, but requires more surgical time and has risks of cement-related complications. Uncemented fixation avoids cement issues but lacks immediate fixation strength and has a risk of fractures. Registry data shows cemented fixation has better long-term survivorship in older patients, while cementless fixation does better in younger patients due to higher activity levels and longer life expectancy. The optimal fixation method depends on the patient's age, bone quality, and lifestyle.

1. Cemented vs Uncemented
Total Hip Arthroplasty
ZAHID ASKAR
FCPS(ORTHO), FRCS (TR & ORTHO)
PROF. & CHAIR
DEPTT OF ORTHOPAEDICS & TRAUMA
KHYBER MEDICAL COLLEGE, PESHAWER

2. Introduction
• Start of Cemented Hips
• Cement Bone Disease
• Younger Patients, higher expectations
• Biologic Bond

3. Cheap
Forgiving
Even in osteoporotic bones
Longer Follow-up
Easier to revise
Biological
No interface between Implant
& Bone
Quicker
Extra Interface
Cementing Techniques
More time
Reaction to Cement
Expensive
Chances of Fracture
Not for every bone

4. • Are all cemented the same ?
• Are all uncemented the same ??
• Hybrid
• Reverse hybrid

5. • Loaded-taper’ or ‘force-closed’
fixation 0r Wedge shaped
prosthesis
• Composite-beam’or ‘shaped-
closed’ fixation Medullary Canal
Filling Prosthesis
‘

6. DOUBLE TAPER – EXETER , CPT
TRIPLE TAPER - MS30, C-STEM ,CPCS( S&N)

7. Advent of Uncemented THA – Role of
Cemented THA ??

8. • Which one is better ?
• Is there a clear answer ?
• Why ???

9. • Individual studies
• Conflicting evidence

10. • Effect of age ?
• One size fits All ??

11. • Registries – conclusive proof for it?
• PRIMARY OSTEOARHRITIS

12. • AOANJRR
• AJRR
• NJR
• THE SWEDISH HIP ARTHROPLASTY REGISTRY
• DANISH JOINT REGISTRY
• NARA
• NORWAY REGISTRY FOR JOINTS
• NEW ZEALAND JOINT REISTRY
• Review Articles

13. Age Distribution of Hip Arthroplasty Procedures,
2012-2018 (N=597,258)

14. Femoral Stem Fixation for Elective Primary Total Hip
Arthroplasty for Patients ≥65 Years of Age with Primary
Osteoarthritis and an Endpoint of Revision, 2012-2018

15. Femoral Stem Fixation for Elective Primary Total Hip
Arthroplasty for Males ≥65 Years of Age with Primary
Osteoarthritis and an Endpoint of Revision, 2012-2018

16. Femoral Stem Fixation for Elective Primary Total Hip Arthroplasty for
Females ≥65 Years of Age with Primary Osteoarthritis and an
Endpoint of Revision, 2012-2018

30. Cemented Fixation have better long term survivorship
Cemented fixation had better survival in older patients
Cementless fixation had better survival in younger patients
Periprosthetic fractures were common in cementless fixation

31. summary
• There seems to be shift towards uncemented THA especially in the
younger patients
• Cemented tends to do relatively better in older patient group
• Not all prosthesis are the same .
• Different Cemented /uncemented THA will have different results