This registry study analyzed 170,413 primary THAs from the Swedish Hip Arthroplasty Register (1992–2007). It asks whether uncemented fixation offers a survival advantage over cemented THA in any patient subgroup, and whether the two constructs fail by different mechanisms.
The trend toward uncemented fixation accelerated globally in the 2000s, partly on the assumption that press-fit osseointegration would outperform cement — especially in younger, more active patients. This registry of 170,413 hips directly tests that assumption at the population level and does not support it.
When counseling patients on fixation type, registry-level data do not justify uncemented THA as superior in any age group. The theoretical osseointegration advantage for younger patients does not translate into better implant survival in this dataset.
If you use an uncemented stem, intraoperative vigilance for femoral fissures during press-fit insertion is critical. The 8-fold excess fracture revision risk in the first 2 years is the strongest actionable number from this paper. These fissures are invisible on plain films and will not declare themselves until the patient falls.
The subanalysis of modern implants offers an important nuance: the gap between fixation types largely reflects legacy cup failures. Contemporary uncemented cup designs perform equivalently or better than common cemented cups, which is why the field has not reversed course despite this registry signal.
This registry study analyzed 170,413 primary THAs from the Swedish Hip Arthroplasty Register (1992–2007). It asks whether uncemented fixation offers a survival advantage over cemented THA in any patient subgroup, and whether the two constructs fail by different mechanisms.
The trend toward uncemented fixation accelerated globally in the 2000s, partly on the assumption that press-fit osseointegration would outperform cement — especially in younger, more active patients. This registry of 170,413 hips directly tests that assumption at the population level and does not support it.
When counseling patients on fixation type, registry-level data do not justify uncemented THA as superior in any age group. The theoretical osseointegration advantage for younger patients does not translate into better implant survival in this dataset.
If you use an uncemented stem, intraoperative vigilance for femoral fissures during press-fit insertion is critical. The 8-fold excess fracture revision risk in the first 2 years is the strongest actionable number from this paper. These fissures are invisible on plain films and will not declare themselves until the patient falls.
The subanalysis of modern implants offers an important nuance: the gap between fixation types largely reflects legacy cup failures. Contemporary uncemented cup designs perform equivalently or better than common cemented cups, which is why the field has not reversed course despite this registry signal.