Cemented total hip arthroplasty reduces early complications: a Japanese nationwide propensity-matched study

INTRODUCTION: The optimal fixation method in total hip arthroplasty (THA) remains under debate. While cemented fixation has been associated with a lower risk of periprosthetic fracture, uncemented fixation predominates in Japan. This study aimed to compare early postoperative complications between cemented and uncemented fixation in elective THA using a nationwide inpatient database. MATERIALS AND METHODS: We identified 198,102 patients aged ≥ 65 years who underwent primary THA for osteoarthritis, osteonecrosis, or rheumatoid arthritis between December 2011 and March 2023 from the Japanese Diagnosis Procedure Combination (DPC) database. After 1:1 propensity score matching for age, sex, body mass index (BMI), and Charlson Comorbidity Index, 36,859 patients were included in each fixation cohort. Surgical and medical complications, and in-hospital mortality were compared using multivariate logistic regression. RESULTS: Cemented fixation was associated with a significantly lower risk of periprosthetic fracture (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.30-0.53; p < 0.001), blood transfusion (OR, 0.76; 95% CI, 0.74-0.78; p < 0.001), and deep vein thrombosis (OR, 0.79; 95% CI, 0.74-0.84; p < 0.001). There were no statistically significant differences based on the predefined threshold (p < 0.001) in dislocation, infection, pulmonary embolism, cardiac or cerebrovascular events, or in-hospital mortality between fixation types, although a trend toward higher in-hospital mortality in the cemented group was observed. CONCLUSIONS: Cemented THA was associated with reduced rates of periprosthetic fracture, transfusion, and deep vein thrombosis without increasing other perioperative or medical complications. These findings suggest that cemented fixation may be associated with favorable short-term outcomes in selected patients.