Ola Rolfson1,2,3, Gabrielle S Donahue3, Mattias Hallsten1,2, Göran Garellick1,2, Johan Kärrholm1,2, Szilard Nemes1,2. 1. Swedish Hip Arthroplasty Register, Gothenburg - Sweden. 2. Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Gothenburg - Sweden. 3. Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston - USA.
Abstract
INTRODUCTION: Data from national registries have favored the use of cemented fixation in total hip replacement (THR) while other reports show no significant differences in implant survival between cemented and uncemented fixation using modern implants. It is important to investigate whether the method of fixation itself may affect patient-reported outcomes. Hence, this study sought to analyse if patient-reported outcomes measures (PROMs) differ depending on the type of fixation. METHODS: Data was used from the follow-up programme of the Swedish Hip Arthroplasty Register which comprises the EQ-5D, a visual analogue scale (VAS) on hip pain, as well as a VAS addressing satisfaction with the outcome of the hip replacement.3,118 patients with uncemented THR due to primary osteoarthritis performed from 2002 to 2011 with complete 1-year follow-up were included in the study. A control group of patients with cemented THR (n = 3,118) were selected by matching on age, gender, Charnley class, and preoperative health-related quality of life. RESULTS: After adjusting for age, gender, Charnley class, and baseline PROMs, multivariate linear regression analyses showed that uncemented fixation is associated with a larger improvement in EQ-5D index (B = 0.03, 95% CI 0.019, 0.041), EQ VAS (B = 2.58, 95% CI 1.65, 3.51), greater pain relief (B = -2.68, 95% CI -3.54, -1.82) and superior patient satisfaction (B = -2.56, 95% CI -3.52, -1.60) (all p<0.001). DISCUSSIONS: This study demonstrates that uncemented fixation is associated with better patient-reported outcomes. Factors unrelated to implant fixation, such as performance or selection bias, may also contribute to the difference.
INTRODUCTION: Data from national registries have favored the use of cemented fixation in total hip replacement (THR) while other reports show no significant differences in implant survival between cemented and uncemented fixation using modern implants. It is important to investigate whether the method of fixation itself may affect patient-reported outcomes. Hence, this study sought to analyse if patient-reported outcomes measures (PROMs) differ depending on the type of fixation. METHODS: Data was used from the follow-up programme of the Swedish Hip Arthroplasty Register which comprises the EQ-5D, a visual analogue scale (VAS) on hip pain, as well as a VAS addressing satisfaction with the outcome of the hip replacement.3,118 patients with uncemented THR due to primary osteoarthritis performed from 2002 to 2011 with complete 1-year follow-up were included in the study. A control group of patients with cemented THR (n = 3,118) were selected by matching on age, gender, Charnley class, and preoperative health-related quality of life. RESULTS: After adjusting for age, gender, Charnley class, and baseline PROMs, multivariate linear regression analyses showed that uncemented fixation is associated with a larger improvement in EQ-5D index (B = 0.03, 95% CI 0.019, 0.041), EQ VAS (B = 2.58, 95% CI 1.65, 3.51), greater pain relief (B = -2.68, 95% CI -3.54, -1.82) and superior patient satisfaction (B = -2.56, 95% CI -3.52, -1.60) (all p<0.001). DISCUSSIONS: This study demonstrates that uncemented fixation is associated with better patient-reported outcomes. Factors unrelated to implant fixation, such as performance or selection bias, may also contribute to the difference.
Authors: Johan Simonsson; Erik Bülow; Karin Svensson Malchau; Fredrik Nyberg; Urban Berg; Ola Rolfson Journal: Acta Orthop Date: 2022-01-03 Impact factor: 3.717