Cemented Femoral Fixation for Primary Total Hip Arthroplasty in the United States: How Surgeon-Cemented Volume Impacts Failure Risk.

BACKGROUND

Although cementless femoral fixation remains the United States (U.S.) standard, recent data shows a decline in exclusive cementless usage from 34 to 14% between 2018 and 2024. Whether surgeon-cemented total hip arthroplasty (THA) volume affects implant survivorship remains unclear in this traditionally low-volume environment. As such, we evaluated the association between surgeon cemented stem volume and risk of all-cause revision.

METHODS

This retrospective cohort study used a national database to identify primary THAs with cemented femoral fixation from 2016 to 2020. Surgeons were classified by their five-year cemented stem volume: Group 1 (less than 60 stems) or Group 2 (≥ 60 stems). Patients had a minimum two-year follow-up and were propensity score-matched 1:1 based on demographics and comorbidities. A total of 7,174 matched patients were analyzed (3,587 per cohort). Outcomes were all-cause revision, periprosthetic fracture (PPF), mechanical loosening, periprosthetic joint infection (PJI), and dislocation within five years.

RESULTS

Patients treated by Group 1 surgeons had higher rates of all study outcomes. At two years, Group 1 patients had higher odds of all-cause revision (odds ratio (OR) = 2.10; 95% confidence interval: 1.44 to 3.11; P < 0.001). Kaplan-Meier analysis showed revision risk diverged sharply within the first postoperative year and persisted through five years. At two-year follow-up, Group 1 patients had increased risk of PPF (OR = 1.58; P = 0.038), loosening (OR = 2.21; P < 0.001), PJI (OR = 2.19; P < 0.001), and dislocation (OR = 2.51; P < 0.001).

CONCLUSIONS

Low surgeon cemented stem volume is strongly associated with increased risk of revision following cemented THA. While cemented femoral fixation remains a useful alternative for high-risk patients undergoing elective THA, the benefits may be compromised if the surgery is performed by surgeons whose specific volume for this type of fixation is low.