Postoperative Infection in Cementless and Cemented Total Knee Arthroplasty: A Propensity Score Matched Analysis.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: C.A.H. reports consultant work from KCI, Pfizer, PSI, TenNor Therapeutics Limited, Zimmer, outside the submitted work; and 3M, American Association of Hip and Knee Surgeons, American Journal of Orthopedics, CD Diagnostics, Cempra, Cymedica, Ferring Pharmaceuticals, Journal of Hip Surgery, Journal of Knee Surgery, Mid-American Orthopaedic Association, Musculoskeletal Infection Society, OREF, Orthofix Inc, Stryker. R.M.M. reports consultant work from Stryker Orthopaedics, outside the submitted work. M.A.M. reports consultant work from Abbott, Cymedica, DJ Orthopaedics, Johnson & Johnson, Mallinckrodt Pharmaceuticals, Microport, Ongoing Care Solutions, Orthosensor, Pacira, Performance Dynamics Inc, Sage, Stryker, TissueGene, outside the submitted work; and AAOS: Board or committee member, Journal of Arthroplasty: Editorial or governing board, Journal of Knee Surgery: Editorial or governing board, Orthopedics: Editorial or governing board, Peerwell: Stock or stock Options, Surgical Techniques International: Editorial or governing board. All the other authors report no conflict of interest. 13. J Clin Med. 2023 Jun 9;12(12):3945. doi: 10.3390/jcm12123945. Cemented versus Cementless Femoral Fixation for Elective Primary Total Hip Arthroplasty: A Nationwide Analysis of Short-Term Complication and Readmission Rates. Chen XT(1), Christ AB(1), Chung BC(1), Ton A(1), Ballatori AM(1), Shahrestani S(1), Gettleman BS(2), Heckmann ND(1). Author information: (1)Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 91803, USA. (2)University of South Carolina School of Medicine, Columbia, SC 29209, USA. Cementless fixation during total hip arthroplasty (THA) is the predominant mode of fixation utilized for both acetabular and femoral components during elective primary THAs performed in the United States. This study aims to compare early complication and readmission rates between primary THA patients receiving cemented versus cementless femoral fixation. The 2016-2017 National Readmissions Database was queried to identify patients undergoing elective primary THA. Postoperative complication and readmission rates at 30, 90, and 180 days were compared between cemented and cementless cohorts. Univariate analysis was conducted to compare differences between cohorts. Multivariate analysis was performed to account for confounding variables. Of 447,902 patients, 35,226 (7.9%) received cemented femoral fixation, while 412,676 (92.1%) did not. The cemented group was older (70.0 vs. 64.8, p < 0.001), more female (65.0% vs. 54.3%, p < 0.001), and more comorbid (CCI 3.65 vs. 3.22, p < 0.001) compared to the cementless group. On univariate analysis, the cemented cohort had decreased odds of periprosthetic fracture at 30 days postoperatively (OR: 0.556, 95%-CI 0.424-0.729, p < 0.0001), but higher odds of hip dislocation, periprosthetic joint infection, aseptic loosening, wound dehiscence, readmission, medical complications, and death at all timepoints. On multivariate analysis, the cemented fixation cohort demonstrated reduced odds of periprosthetic fracture at all postoperative timepoints: 30 (OR: 0.350, 95%-CI 0.233-0.506, p < 0.0001), 90 (OR: 0.544, 95%-CI 0.400-0.725, p < 0.0001), and 180 days (OR: 0.573, 95%-CI 0.396-0.803, p = 0.002). Cemented femoral fixation was associated with significantly fewer short-term periprosthetic fractures, but more unplanned readmissions, deaths, and postoperative complications compared to cementless femoral fixation in patients undergoing elective THA. DOI: 10.3390/jcm12123945 PMCID: PMC10299501