Do we really need cement in elderly patient? Efficacy of hydroxyapatite cementless femoral stem in primary hip arthroplasty in elderly patients

Background. Bone cement implantation syndrome remains a serious complication in elderly patients undergoing cemented total hip arthroplasty. Cementless femoral stems with hydroxyapatite (HA) coating have been proposed as a viable alternative, offering potential improvements in osteointegration and reduction in bone cement implantation syndrome incidence. This study aimed to evaluate the efficacy and stability of HA-coated cementless femoral stems in elderly patients undergoing primary hip arthroplasty. Materials and ­methods. A prospective case series was conducted on 34 patients aged ≥ 65 years who underwent cementless hip arthroplasty between November 2021 and February 2022. Of these, 30 completed follow-up and were included in the final analysis. Radiographic stem subsidence was measured using Engh and Massin’s method at 6 months, 1, and 2 years. Functional outcomes were assessed via the Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), and Visual Analog Scale (VAS). Subgroup analyses explored associations with anti-osteoporotic therapy and smoking status. Results. Mean stem subsidence progressively increased over time, reaching 1.92 ± 0.34 mm at 2 years (p < 0.001). Functional outcomes significantly improved across all time points: HHS increased from 54.7 to 87.3 (p < 0.001), HOOS from 48.1 to 85.9 (p < 0.001), and VAS decreased from 7.2 to 2.1 (p < 0.001). Patients receiving anti-osteoporotic therapy had significantly lower subsidence (p < 0.001), while smokers demonstrated higher subsidence at all intervals (p = 0.007). Conclusions. HA-coated cementless femoral stems are a reliable option in elderly patients, demonstrating low subsidence, favorable functional recovery, and minimal complications. Anti-osteoporotic therapy may enhance implant stability, while smoking poses a significant risk to fixation integrity.