Abstract：
BACKGROUND: This investigation examined cemented femoral component use in total hip arthroplasty (THA) and its impact on the incidence of periprosthetic fractures (PPFx), a common failure mode in THA. The study leverages data from the American Joint Replacement Registry (AJRR) to assess trends in cemented femoral component usage over time, its association with PPFx rates, and compares the survivorship and 90-day complication rates between cemented and cementless femoral component THAs.
METHODS: Primary THAs, captured in the AJRR, in patients aged 65 years and older from 2012 to 2021 were analyzed. Variables considered included age, sex, race, region, teaching status, year, Charlson comorbidity index, and institution bed size. Analysis compared fixation types for THA on all-cause linked revision and PPFx. Logistic regression models analyzed the odds ratios for all-cause linked revision and PPFx for any follow-up time as well as for 90-day revision. The models were adjusted for the listed variables.
RESULTS: During the study period, the rate of cement utilization as a percentage of primary THAs performed and reported to the AJRR increased from 4.4 to 8.3%. The rate of THA failure from PPFx increased from 11.4 to 33.3%. When both fixation groups were compared in the univariate analysis, there was a statistically significant difference in all demographic variables (P < .001). To account for this, multivariable logistic regression models were applied. In our models, cemented stems showed a 54.4% (odds ratio: 0.456; 95% confidence interval: 0.347 to 0.599; P < .0001) and 65.8% (odds ratio: 0.342; 95% confidence interval: 0.237 to 0.493; P < .0001) lower risk of PPFx linked and PPFx early linked revision, respectively.
CONCLUSIONS: Periprosthetic fractures are becoming a leading failure mode for THAs in the AJRR. Given cemented fixation\'s relative resistance to this failure mode compared to cementless fixation, we should consider increasing the utilization of this technique.
METHODS: Primary THAs, captured in the AJRR, in patients aged 65 years and older from 2012 to 2021 were analyzed. Variables considered included age, sex, race, region, teaching status, year, Charlson comorbidity index, and institution bed size. Analysis compared fixation types for THA on all-cause linked revision and PPFx. Logistic regression models analyzed the odds ratios for all-cause linked revision and PPFx for any follow-up time as well as for 90-day revision. The models were adjusted for the listed variables.
RESULTS: During the study period, the rate of cement utilization as a percentage of primary THAs performed and reported to the AJRR increased from 4.4 to 8.3%. The rate of THA failure from PPFx increased from 11.4 to 33.3%. When both fixation groups were compared in the univariate analysis, there was a statistically significant difference in all demographic variables (P < .001). To account for this, multivariable logistic regression models were applied. In our models, cemented stems showed a 54.4% (odds ratio: 0.456; 95% confidence interval: 0.347 to 0.599; P < .0001) and 65.8% (odds ratio: 0.342; 95% confidence interval: 0.237 to 0.493; P < .0001) lower risk of PPFx linked and PPFx early linked revision, respectively.
CONCLUSIONS: Periprosthetic fractures are becoming a leading failure mode for THAs in the AJRR. Given cemented fixation\'s relative resistance to this failure mode compared to cementless fixation, we should consider increasing the utilization of this technique.
摘要：
背景：这项研究检查了全髋关节置换术（THA）中骨水泥股骨组件的使用及其对假体周围骨折（PPFx）发生率的影响，THA中的常见故障模式。该研究利用美国关节置换登记处（AJRR）的数据来评估股骨骨水泥部件使用随时间的趋势。它与PPFx费率的关联，并比较了骨水泥和非骨水泥股骨THA之间的生存率和90天并发症发生率。
方法：主要THA，在AJRR中被捕获，对2012年至2021年年龄在65岁及以上的患者进行了分析。考虑的变量包括年龄，性别,种族,区域,教学现状,Year,Charlson合并症指数（CCI），和机构床的大小。分析比较了全因相关翻修和PPFx上THA的固定类型。Logistic回归模型分析了任何随访时间以及90天修订的全因相关修订和PPFx的比值比。针对列出的变量调整了模型。
结果：在研究期间，水泥利用率占执行并报告给AJRR的主要THA的百分比从4.4%增加到8.3%。PPFx的THA失败率从11.4增加到33.3%。当在单因素分析中比较两个固定组时，所有人口统计学变量均有统计学差异(P<0.001).为此，采用多变量logistic回归模型。在我们的模型中,胶结茎显示54.4%（OR[比值比]：0.456，95%CI[置信区间]：0.347至0.599，P<0.0001）和65.8%（OR：0.342，95%CI：0.237至0.493，P<0.0001）的PPFx关联和PPFx早期关联修订的风险较低，分别。
结论：假体周围骨折正在成为AJRR中THA的主要失效模式。考虑到与非骨水泥固定相比，骨水泥固定对这种失效模式的相对抵抗力，我们应该考虑提高这项技术的利用率。
方法：主要THA，在AJRR中被捕获，对2012年至2021年年龄在65岁及以上的患者进行了分析。考虑的变量包括年龄，性别,种族,区域,教学现状,Year,Charlson合并症指数（CCI），和机构床的大小。分析比较了全因相关翻修和PPFx上THA的固定类型。Logistic回归模型分析了任何随访时间以及90天修订的全因相关修订和PPFx的比值比。针对列出的变量调整了模型。
结果：在研究期间，水泥利用率占执行并报告给AJRR的主要THA的百分比从4.4%增加到8.3%。PPFx的THA失败率从11.4增加到33.3%。当在单因素分析中比较两个固定组时，所有人口统计学变量均有统计学差异(P<0.001).为此，采用多变量logistic回归模型。在我们的模型中,胶结茎显示54.4%（OR[比值比]：0.456，95%CI[置信区间]：0.347至0.599，P<0.0001）和65.8%（OR：0.342，95%CI：0.237至0.493，P<0.0001）的PPFx关联和PPFx早期关联修订的风险较低，分别。
结论：假体周围骨折正在成为AJRR中THA的主要失效模式。考虑到与非骨水泥固定相比，骨水泥固定对这种失效模式的相对抵抗力，我们应该考虑提高这项技术的利用率。
