Trends in Hip Arthroplasty Cementation: Insights from an Italian Registry of 142,113 Patients

Introduction: The use of cementation in total hip arthroplasty (THA) has evolved over the years, with a notable shift toward cementless and hybrid techniques. The aim of this study is to evaluate data from an Italian registry on the type of fixation used in THA implants and their corresponding survival rates in a large patient cohort with long-term follow-up, and to compare these data with the most recent literature. Methods: From January 2000 to December 2020, a total of 137,256 primary THA procedures were performed, of which 10.4% were fixed with stem cementation. There were 4857 revision implants, of which 11.4% were implanted with stem cementation. Results: The trend showing a significant shift toward cementless fixation methods is particularly pronounced in younger patients, with cementless implants comprising 99.5% of procedures in patients under 40 years of age. As patient age increases, the use of cemented or hybrid fixation methods becomes more common. This trend aligns with existing literature, in which cementation is often preferred for elderly patients due to concerns about bone quality and the potential for better immediate fixation provided by cemented stems. At 10 years, the implant that showed the highest survival rate was the fully cemented implant, with a rate of 94.8%. This study also reports the causes of failure based on the different fixation techniques. Conclusions: The development of standardized guidelines that consider patient-specific factors such as age, bone quality, and comorbidities in the choice of fixation type could help reduce variability in practice and improve overall outcomes in hip arthroplasty.