Cementless femoral fixation in primary total hip arthroplasty (THA) is the dominant choice in the United States, fueled by its immense surgical versatility and robust long-term survivorship in younger demographics. However, when treating the elderly patientâspecifically those 75 years of age and olderâa deep-seated clinical controversy emerges. Based largely on national joint registry data, cementless fixation in older patients is heavily scrutinized due to reported spikes in periprosthetic fractures and early aseptic loosening. Consequently, cemented femoral stems remain the entrenched âgold standardâ for the geriatric population in many parts of the world.
Advocates of cement argue that poor bone quality intrinsically sabotages the initial osseointegration required for press-fit stems, necessitating immediate acrylic fixation. Conversely, proponents of cementless THA point to the deadly risks of bone cement implantation syndrome (BCIS) and highlight that optimized modern surgical techniques effectively neutralize the risk of early implant subsidence without the use of cement. Adding to the debate is the recent resurgence of collared cementless stems, heavily marketed as a fail-safe against subsidence in frail bone.
