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Online ISSN 1827-1707
Moss L. 1, Khatod M. 2
1 Department of Orthopaedic Surgery, Harbor UCLA Medical Center, Los Angeles, CA, USA;
2 Department of Orthopaedic Surgery, Southern California Permanente Group, Los Angeles, CA, USA
Total hip replacement (THR) is a commonly performed and successful orthopedic procedure, yet there remains controversy regarding the choice of femoral fixation. Historically there has been a divide between North America and Europe, with the US and Canada more frequently using cementless implants and European countries using cemented implants.Despite these historical differences, the use of cementless implants has increased over the last decade in nearly every country worldwide. Excellent outcomes of both cemented and cementless THRs have been well documented. Numerous cohort studies have demonstrated excellent long-term survival with respect to aseptic loosening of modern cementless femoral implants, exceeding those of many cemented stems, especially in younger age groups. Recently, long-term results from randomized trials comparing the two methods of fixation have demonstrated better survival rates of cementless stems. Despite the growing body of literature to support the superiority of cementless femoral fixation, support from national registry data has been variable. We believe a shift has occurred in the international Orthopaedic community in that cementless stems have become the new gold standard for femoral fixation in total hip arthroplasty. In this article we review the current literature regarding cementless femoral fixation in primary THR.