Skip to main content
Top
Published in: Clinical Orthopaedics and Related Research® 6/2009

01-06-2009 | Original Article

Cementless Femoral Prostheses Cost More to Implant than Cemented Femoral Prostheses

Authors: Aasis Unnanuntana, MD, Apostolos Dimitroulias, MD, Michael P. Bolognesi, MD, Katherine L. Hwang, MS, Stuart B. Goodman, MD, PhD, Randall E. Marcus, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 6/2009

Login to get access

Abstract

Prosthetic cost contributes greatly to the overall expense of THA. A key question, therefore, in the selection of implant technique is whether any price difference exists between a cementless and a cemented femoral prosthesis. We evaluated the price difference between the most commonly used cemented and cementless femoral stems at three high-volume academic medical centers. Each hospital’s costs for prostheses from the manufacturers were recorded. The average cost of implanting a cementless femoral prosthesis was $296 more than the average cost of implanting a cemented femoral stem, even with the additional expense of two batches of bone cement and the accessories commonly used to achieve a third-generation cementing technique. The price difference was less variable if the cost of the prostheses from only the primary implant supplier for each institution was considered. As the number of THAs performed per year continues to escalate, implantation of a cemented femoral component remains an attractive method of fixation from an economic standpoint.
Level of Evidence: Level III, economic and decision analysis. See the Guidelines for Authors for a complete description of levels of evidence.
Literature
1.
go back to reference Barber TC, Healy WL. The hospital cost of total hip arthroplasty: a comparison between 1981 and 1990. J Bone Joint Surg Am. 1993;75:321–325.PubMed Barber TC, Healy WL. The hospital cost of total hip arthroplasty: a comparison between 1981 and 1990. J Bone Joint Surg Am. 1993;75:321–325.PubMed
2.
go back to reference Barrack RL, Castro F, Guinn S. Cost of implanting a cemented versus cementless femoral stem. J Arthroplasty. 1996;11:373–376.PubMedCrossRef Barrack RL, Castro F, Guinn S. Cost of implanting a cemented versus cementless femoral stem. J Arthroplasty. 1996;11:373–376.PubMedCrossRef
3.
go back to reference Barrack RL, Mulroy RD Jr, Harris WH. Improved cementing techniques and femoral component loosening in young patients with hip arthroplasty: a 12-year radiographic review. J Bone Joint Surg Br. 1992;74:385–389.PubMed Barrack RL, Mulroy RD Jr, Harris WH. Improved cementing techniques and femoral component loosening in young patients with hip arthroplasty: a 12-year radiographic review. J Bone Joint Surg Br. 1992;74:385–389.PubMed
5.
go back to reference Birrell F, Johnell O, Silman A. Projecting the need for hip replacement over the next three decades: influence of changing demography and threshold for surgery. Ann Rheum Dis. 1999;58:569–572.PubMedCrossRef Birrell F, Johnell O, Silman A. Projecting the need for hip replacement over the next three decades: influence of changing demography and threshold for surgery. Ann Rheum Dis. 1999;58:569–572.PubMedCrossRef
6.
go back to reference Callaghan JJ, Liu SS, Firestone DE, Yehyawi TM, Goetz DD, Sullivan J, Vittetoe DA, O’Rourke MR, Johnston RC. Total hip arthroplasty with cement and use of a collared matte-finish femoral component: nineteen to twenty-year follow-up. J Bone Joint Surg Am. 2008;90:299–306.PubMedCrossRef Callaghan JJ, Liu SS, Firestone DE, Yehyawi TM, Goetz DD, Sullivan J, Vittetoe DA, O’Rourke MR, Johnston RC. Total hip arthroplasty with cement and use of a collared matte-finish femoral component: nineteen to twenty-year follow-up. J Bone Joint Surg Am. 2008;90:299–306.PubMedCrossRef
7.
go back to reference Clohisy JC, Harris WH. Primary hybrid total hip replacement, performed with insertion of the acetabular component without cement and a precoat femoral component with cement: an average ten-year follow-up study. J Bone Joint Surg Am. 1999;81:247–255.PubMed Clohisy JC, Harris WH. Primary hybrid total hip replacement, performed with insertion of the acetabular component without cement and a precoat femoral component with cement: an average ten-year follow-up study. J Bone Joint Surg Am. 1999;81:247–255.PubMed
8.
go back to reference Engh CA Jr, Claus AM, Hopper RH Jr, Engh CA. Long-term results using the anatomic medullary locking hip prosthesis. Clin Orthop Relat Res. 2001;393:137–146.PubMedCrossRef Engh CA Jr, Claus AM, Hopper RH Jr, Engh CA. Long-term results using the anatomic medullary locking hip prosthesis. Clin Orthop Relat Res. 2001;393:137–146.PubMedCrossRef
9.
go back to reference Ereth MH, Weber JG, Abel MD, Lennon RL, Lewallen DG, Ilstrup DM, Rehder K. Cemented versus noncemented total hip arthroplasty: embolism, hemodynamics, and intrapulmonary shunting. Mayo Clin Proc. 1992;67:1066–1074.PubMed Ereth MH, Weber JG, Abel MD, Lennon RL, Lewallen DG, Ilstrup DM, Rehder K. Cemented versus noncemented total hip arthroplasty: embolism, hemodynamics, and intrapulmonary shunting. Mayo Clin Proc. 1992;67:1066–1074.PubMed
10.
go back to reference Firestone DE, Callaghan JJ, Liu SS, Goetz DD, Sullivan PM, Vittetoe DA, Johnston RC. Total hip arthroplasty with a cemented, polished, collared femoral stem and a cementless acetabular component: a follow-up study at a minimum of ten years. J Bone Joint Surg Am. 2007;89:126–132.PubMedCrossRef Firestone DE, Callaghan JJ, Liu SS, Goetz DD, Sullivan PM, Vittetoe DA, Johnston RC. Total hip arthroplasty with a cemented, polished, collared femoral stem and a cementless acetabular component: a follow-up study at a minimum of ten years. J Bone Joint Surg Am. 2007;89:126–132.PubMedCrossRef
11.
go back to reference Francis CW, Marder VJ, Evarts CM. Lower risk of thromboembolic disease after total hip replacement with non-cemented than with cemented prostheses. Lancet. 1986;1:769–771.PubMedCrossRef Francis CW, Marder VJ, Evarts CM. Lower risk of thromboembolic disease after total hip replacement with non-cemented than with cemented prostheses. Lancet. 1986;1:769–771.PubMedCrossRef
12.
go back to reference Hannan EL, Racz M, Kavey RE, Quaegebeur JM, Williams R. Pediatric cardiac surgery: the effect of hospital and surgeon volume on in-hospital mortality. Pediatrics. 1998;101:963–969.PubMedCrossRef Hannan EL, Racz M, Kavey RE, Quaegebeur JM, Williams R. Pediatric cardiac surgery: the effect of hospital and surgeon volume on in-hospital mortality. Pediatrics. 1998;101:963–969.PubMedCrossRef
13.
go back to reference Healy WL, Iorio R. Implant selection and cost for total hip arthroplasty: conflict between surgeons and hospitals. Clin Orthop Relat Res. 2007;457:57–63.PubMed Healy WL, Iorio R. Implant selection and cost for total hip arthroplasty: conflict between surgeons and hospitals. Clin Orthop Relat Res. 2007;457:57–63.PubMed
14.
go back to reference Huo MH, Gilbert NF, Parvizi J. What’s new in total hip arthroplasty. J Bone Joint Surg Am. 2007;89:1874–1885.PubMedCrossRef Huo MH, Gilbert NF, Parvizi J. What’s new in total hip arthroplasty. J Bone Joint Surg Am. 2007;89:1874–1885.PubMedCrossRef
15.
go back to reference Katz JN, Losina E, Barrett J, Phillips CB, Mahomed NN, Lew RA, Guadagnoli E, Harris WH, Poss R, Baron JA. Association between hospital and surgeon procedure volume and outcomes of total hip replacement in the United States Medicare population. J Bone Joint Surg Am. 2001;83:1622–1629.PubMedCrossRef Katz JN, Losina E, Barrett J, Phillips CB, Mahomed NN, Lew RA, Guadagnoli E, Harris WH, Poss R, Baron JA. Association between hospital and surgeon procedure volume and outcomes of total hip replacement in the United States Medicare population. J Bone Joint Surg Am. 2001;83:1622–1629.PubMedCrossRef
16.
go back to reference Kim YH, Suh JS. Low incidence of deep-vein thrombosis after cementless total hip replacement. J Bone Joint Surg Am. 1988;70:878–882.PubMed Kim YH, Suh JS. Low incidence of deep-vein thrombosis after cementless total hip replacement. J Bone Joint Surg Am. 1988;70:878–882.PubMed
17.
go back to reference Klapach AS, Callaghan JJ, Goetz DD, Olejniczak JP, Johnston RC. Charnley total hip arthroplasty with use of improved cementing techniques: a minimum twenty-year follow-up study. J Bone Joint Surg Am. 2001;83:1840–1848.PubMed Klapach AS, Callaghan JJ, Goetz DD, Olejniczak JP, Johnston RC. Charnley total hip arthroplasty with use of improved cementing techniques: a minimum twenty-year follow-up study. J Bone Joint Surg Am. 2001;83:1840–1848.PubMed
18.
go back to reference Laupacis A, Bourne R, Rorabeck C, Feeny D, Wong C, Tugwell P, Leslie K, Bullas R. Costs of elective total hip arthroplasty during the first year: cemented versus noncemented. J Arthroplasty. 1994;9:481–487.PubMedCrossRef Laupacis A, Bourne R, Rorabeck C, Feeny D, Wong C, Tugwell P, Leslie K, Bullas R. Costs of elective total hip arthroplasty during the first year: cemented versus noncemented. J Arthroplasty. 1994;9:481–487.PubMedCrossRef
19.
go back to reference Lavernia CJ, Guzman JF. Relationship of surgical volume to short-term mortality, morbidity, and hospital charges in arthroplasty. J Arthroplasty. 1995;10:133–140.PubMedCrossRef Lavernia CJ, Guzman JF. Relationship of surgical volume to short-term mortality, morbidity, and hospital charges in arthroplasty. J Arthroplasty. 1995;10:133–140.PubMedCrossRef
20.
go back to reference Lin DH, Jan MH, Liu TK, Lin YF, Hou SM. Effects of anterolateral minimally invasive surgery in total hip arthroplasty on hip muscle strength, walking speed, and functional score. J Arthroplasty. 2007;22:1187–1192.PubMedCrossRef Lin DH, Jan MH, Liu TK, Lin YF, Hou SM. Effects of anterolateral minimally invasive surgery in total hip arthroplasty on hip muscle strength, walking speed, and functional score. J Arthroplasty. 2007;22:1187–1192.PubMedCrossRef
21.
go back to reference Martineau P, Filion KB, Huk OL, Zukor DJ, Eisenberg MJ, Antoniou J. Primary hip arthroplasty costs are greater in low-volume than in high-volume Canadian hospitals. Clin Orthop Relat Res. 2005;437:152–156.PubMedCrossRef Martineau P, Filion KB, Huk OL, Zukor DJ, Eisenberg MJ, Antoniou J. Primary hip arthroplasty costs are greater in low-volume than in high-volume Canadian hospitals. Clin Orthop Relat Res. 2005;437:152–156.PubMedCrossRef
22.
go back to reference McLaughlin JR, Lee KR. Total hip arthroplasty with an uncemented tapered femoral component. J Bone Joint Surg Am. 2008;90:1290–1296.PubMedCrossRef McLaughlin JR, Lee KR. Total hip arthroplasty with an uncemented tapered femoral component. J Bone Joint Surg Am. 2008;90:1290–1296.PubMedCrossRef
23.
go back to reference McNally SA, Shepperd JA, Mann CV, Walczak JP. The results at nine to twelve years of the use of a hydroxyapatite-coated femoral stem. J Bone Joint Surg Br. 2000;82:378–382.PubMedCrossRef McNally SA, Shepperd JA, Mann CV, Walczak JP. The results at nine to twelve years of the use of a hydroxyapatite-coated femoral stem. J Bone Joint Surg Br. 2000;82:378–382.PubMedCrossRef
24.
go back to reference Meding JB, Keating EM, Ritter MA, Faris PM, Berend ME. Minimum ten-year follow-up of a straight-stemmed, plasma-sprayed, titanium-alloy, uncemented femoral component in primary total hip arthroplasty. J Bone Joint Surg Am. 2004;86:92–97.PubMed Meding JB, Keating EM, Ritter MA, Faris PM, Berend ME. Minimum ten-year follow-up of a straight-stemmed, plasma-sprayed, titanium-alloy, uncemented femoral component in primary total hip arthroplasty. J Bone Joint Surg Am. 2004;86:92–97.PubMed
25.
go back to reference Meding JB, Nassif JM, Ritter MA. Long-term survival of the T–28 versus the TR–28 cemented total hip arthroplasties. J Arthroplasty. 2000;15:928–933.PubMedCrossRef Meding JB, Nassif JM, Ritter MA. Long-term survival of the T–28 versus the TR–28 cemented total hip arthroplasties. J Arthroplasty. 2000;15:928–933.PubMedCrossRef
26.
go back to reference Mendenhall S. Hip and knee implant prices rise 8.9%. Orthopedic Network News. 2005;16:1–16. Mendenhall S. Hip and knee implant prices rise 8.9%. Orthopedic Network News. 2005;16:1–16.
27.
go back to reference Morshed S, Bozic KJ, Ries MD, Malchau H, Colford JM Jr. Comparison of cemented and uncemented fixation in total hip replacement: a meta-analysis. Acta Orthop. 2007;78:315–326.PubMedCrossRef Morshed S, Bozic KJ, Ries MD, Malchau H, Colford JM Jr. Comparison of cemented and uncemented fixation in total hip replacement: a meta-analysis. Acta Orthop. 2007;78:315–326.PubMedCrossRef
28.
go back to reference Mulroy RD Jr, Harris WH. The effect of improved cementing techniques on component loosening in total hip replacement: an 11-year radiographic review. J Bone Joint Surg Br. 1990;72:757–760.PubMed Mulroy RD Jr, Harris WH. The effect of improved cementing techniques on component loosening in total hip replacement: an 11-year radiographic review. J Bone Joint Surg Br. 1990;72:757–760.PubMed
29.
go back to reference Murphy SB, Tannast M. Conventional vs minimally invasive total hip arthroplasty. A prospective study of rehabilitation and complications. Orthopade. 2006;35:761–764.PubMedCrossRef Murphy SB, Tannast M. Conventional vs minimally invasive total hip arthroplasty. A prospective study of rehabilitation and complications. Orthopade. 2006;35:761–764.PubMedCrossRef
30.
go back to reference Ries MD, Lynch F, Rauscher LA, Richman J, Mick C, Gomez M. Pulmonary function during and after total hip replacement: findings in patients who have insertion of a femoral component with and without cement. J Bone Joint Surg Am. 1993;75:581–587.PubMed Ries MD, Lynch F, Rauscher LA, Richman J, Mick C, Gomez M. Pulmonary function during and after total hip replacement: findings in patients who have insertion of a femoral component with and without cement. J Bone Joint Surg Am. 1993;75:581–587.PubMed
31.
go back to reference Sanchez-Sotelo J, Berry DJ, Harmsen S. Long-term results of use of collared matte-finished femoral component fixed with second-generation cementing techniques: a fifteen-year-median follow-up study. J Bone Joint Surg Am. 2002;84:1636–1641.PubMedCrossRef Sanchez-Sotelo J, Berry DJ, Harmsen S. Long-term results of use of collared matte-finished femoral component fixed with second-generation cementing techniques: a fifteen-year-median follow-up study. J Bone Joint Surg Am. 2002;84:1636–1641.PubMedCrossRef
32.
go back to reference Sarmiento A, Latta LL. A radiographic review of 135 total hip Charnley arthroplasties followed between 15 and 35 years. Acta Chir Orthop Traumatol Cech. 2006;73:145–150.PubMed Sarmiento A, Latta LL. A radiographic review of 135 total hip Charnley arthroplasties followed between 15 and 35 years. Acta Chir Orthop Traumatol Cech. 2006;73:145–150.PubMed
33.
go back to reference Schulte KR, Callaghan JJ, Kelly SS, Johnston RC. The outcome of Charnley total hip arthroplasty with cement after a minimum twenty-year follow-up: the results of one surgeon. J Bone Joint Surg Am. 1993;75:961–975.PubMed Schulte KR, Callaghan JJ, Kelly SS, Johnston RC. The outcome of Charnley total hip arthroplasty with cement after a minimum twenty-year follow-up: the results of one surgeon. J Bone Joint Surg Am. 1993;75:961–975.PubMed
34.
go back to reference Skutek M, Bourne RB, Rorabeck CH, Burns A, Kearns S, Krishna G. The twenty to twenty-five-year outcomes of the Harris design–2 matte-finished cemented total hip replacement: a concise follow-up of a previous report. J Bone Joint Surg Am. 2007;89:814–818.PubMedCrossRef Skutek M, Bourne RB, Rorabeck CH, Burns A, Kearns S, Krishna G. The twenty to twenty-five-year outcomes of the Harris design–2 matte-finished cemented total hip replacement: a concise follow-up of a previous report. J Bone Joint Surg Am. 2007;89:814–818.PubMedCrossRef
35.
go back to reference Sosa JA, Bowman HM, Gordon TA, Bass EB, Yeo CJ, Lillemoe KD, Pitt HA, Tielsch JM, Cameron JL. Importance of hospital volume in the overall management of pancreatic cancer. Ann Surg. 1998;228:429–438.PubMedCrossRef Sosa JA, Bowman HM, Gordon TA, Bass EB, Yeo CJ, Lillemoe KD, Pitt HA, Tielsch JM, Cameron JL. Importance of hospital volume in the overall management of pancreatic cancer. Ann Surg. 1998;228:429–438.PubMedCrossRef
36.
go back to reference Vidalain JP. HA coating: ten-year experience with the CORAIL system in primary THA. The Artro group. Acta Orthop Belg. 1997;63(suppl 1):93–95.PubMed Vidalain JP. HA coating: ten-year experience with the CORAIL system in primary THA. The Artro group. Acta Orthop Belg. 1997;63(suppl 1):93–95.PubMed
37.
go back to reference Waldman BJ. Advancements in minimally invasive total hip arthroplasty. Orthopedics. 2003;26(8 Suppl):s833–s836.PubMed Waldman BJ. Advancements in minimally invasive total hip arthroplasty. Orthopedics. 2003;26(8 Suppl):s833–s836.PubMed
38.
go back to reference Xenos JS, Callaghan JJ, Heekin RD, Hopkinson WJ, Savory CG, Moore MS. The porous-coated anatomic total hip prosthesis, inserted without cement: a prospective study with a minimum of ten years of follow-up. J Bone Joint Surg Am. 1999;81:74–82.PubMed Xenos JS, Callaghan JJ, Heekin RD, Hopkinson WJ, Savory CG, Moore MS. The porous-coated anatomic total hip prosthesis, inserted without cement: a prospective study with a minimum of ten years of follow-up. J Bone Joint Surg Am. 1999;81:74–82.PubMed
39.
go back to reference Yates P, Serjeant S, Rushforth G, Middleton R. The relative cost of cemented and uncemented total hip arthroplasties. J Arthroplasty. 2006;21:102–105.PubMedCrossRef Yates P, Serjeant S, Rushforth G, Middleton R. The relative cost of cemented and uncemented total hip arthroplasties. J Arthroplasty. 2006;21:102–105.PubMedCrossRef
Metadata
Title
Cementless Femoral Prostheses Cost More to Implant than Cemented Femoral Prostheses
Authors
Aasis Unnanuntana, MD
Apostolos Dimitroulias, MD
Michael P. Bolognesi, MD
Katherine L. Hwang, MS
Stuart B. Goodman, MD, PhD
Randall E. Marcus, MD
Publication date
01-06-2009
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 6/2009
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-008-0485-z

Other articles of this Issue 6/2009

Clinical Orthopaedics and Related Research® 6/2009 Go to the issue

Symposium: Advanced Techniques for Rehabilitation after Total Hip and Knee Arthroplasty

Pilates Training for Use in Rehabilitation after Total Hip and Knee Arthroplasty: A Preliminary Report