# Femoral Fixation for Primary Total Hip Arthroplasty—An International Registry Perspective

## TL;DR

This study examines global trends in femoral fixation methods for hip replacement surgery, showing a shift toward uncemented techniques, except in some countries.

## Contribution

The study provides the first comprehensive international comparison of femoral fixation trends and outcomes in primary total hip arthroplasty.

## Key findings

- A global shift from cemented to uncemented femoral fixation was observed over the past two decades.
- Survival rates for cemented and uncemented methods were comparable, but periprosthetic fracture rates varied regionally.
- Cemented fixation remains popular in some countries due to differing clinical needs and practices.

## Abstract

The preferred method for femoral fixation (FF) during total hip arthroplasty (THA) has varied internationally. While prior studies explored trends within single countries or small international cohorts, there’s a paucity of studies comparing international trends of FF for primary THA patients. This study analyzed global trends in FF methods, survival by fixation type, and periprosthetic fractures as a reason for revision.

Data were extracted from 2000 to the present from 16 national joint replacement registries. Data were collected on the number of cemented and uncemented primary THA cases each year. Revision and survival data were analyzed by fixation method. Aggregate data on periprosthetic fractures as a reason for revision and specific data on periprosthetic fractures by fixation method were included when available.

A global shift from cemented to uncemented FF was observed over the past two decades, except in the Netherlands. Even in countries favoring cementation, such as Sweden, uncemented techniques are gaining popularity. Survival rates for cemented and uncemented methods were comparable, but periprosthetic fracture rates varied regionally. Preferences reflected both clinical practice differences and patient needs.

Most countries investigated show a preference for uncemented fixation. However, the popularity of cemented fixation in certain countries reflects its continued relevance, especially in populations with different clinical needs. Survival by fixation method was similar among countries, but periprosthetic fracture as reason for revision varied widely.