The purpose of this randomized clinical trial was to compare the >20-year outcomes of cemented (n=124) versus cementless (n=126) total hip replacements (THRs) in patients with end-stage, unilateral hip osteoarthritis. At 20 years, 168 patients (67%) were available for follow-up, 78 (31%) had died, and 4 (2%) were lost. A power analysis was performed to determine the number of patients needed in each study cohort. Patients were assessed pre- and postoperatively by validated disease-specific Western Ontario McMaster Osteoarthritis Score, patient-specific McMaster Arthritis Score, global health (sickness impact profile), functional capacity (6-minute walk), and cost utility (cost-to-quality adjusted life years). Patients were followed every 2 years clinically and radiographically.The cementless THR outperformed its cemented counterpart in terms of overall (P=.01), socket (P=.009), and stem (P<.0001) Kaplan-Meier survivorships. Patients younger than 65 years had significantly poorer cemented and cementless socket survivorships, and male sex adversely affected cementless socket survivorship. The cementless tapered stem had 100% survivorship with aseptic loosening as the endpoint at 20 years. Although this study has demonstrated the superiority of the cementless THR over its cemented counterpart, care must be taken in generalizing these results to other cemented and cementless THRs.
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