Who should get a cemented arthroplasty and who should get a cementless prosthesis?
In the hip, this is an area of controversy. Conventional wisdom in the United States suggests that younger, active patients with good bone quality in whom intimate apposition of prosthesis to bone can be achieved intraoperatively are the best candidates for cementless THA. This is usually a patient aged <50 to 60 years with OA of the hip. Cemented prostheses remain the “gold standard” and preferred in patients with RA with poor bone stock, in the elderly with low activity levels, and in hybrid hip implants. Regardless of the prosthesis, over 90% of THAs are pain-free and without complications 10 to 15 years postoperatively.
In the knee, cemented implants (posterior cruciate retaining, posterior stabilized condylar, and total condylar prosthesis) demonstrate 90% to 95% satisfactory results at 5 to 10 years for both patients with RA and OA. Cementless prostheses have not been successful as a result of poor bone ingrowth on the patella and tibial components. In the hybrid knee replacement, the cementless component is reserved for the femur, whereas tibia and patella components are cemented.