There were almost 650,000 total hip replacement procedures performed in Europe in 2017, with the majority completed using cementless implants. This total number, which includes replacements utilizing cemented, cementless, and hybrid cemented device options, is projected to increase and will surpass 730,000 by 2024. However, the movement toward cementless implants seems to be slowing as other technologies become more prevalent.
Similar to the orthopedic market in the United States, cementless hip implants remain the most popular option for total hip replacement in the European region. However, the portion of the cementless hip market in the United States is considerably higher than in Europe. Moreover, while cementless hips will likely continue to cannibalize other cementation types in the United States, the European orthopedic community is expected to increasingly adopt hybrid implants that comprise both cemented and uncemented components. Between 2017 and 2024, hybrid hip implants are projected to exhibit the fastest growth in the total hip replacement market in Europe.
Advantages and Disadvantages of Cementless Implants
The superiority of one fixation type over another has been argued by different experts in recent years, as different implant options are associated with a number of advantages and drawbacks. While all fixation methods, including cemented, cementless, and hybrid have been successfully used in hip arthroplasty over the years, their usage trends differ across the globe.
One of the significant benefits of cemented implant components is their lower cost compared to cementless options because of the added cost of the porous metal coatings necessary to achieve bone infiltration. As a result, hip replacements using cemented implants are generally the least expensive total hip arthroplasty option worldwide. Another advantage of cemented implants is their use in patients with a poor bone structure or a lack of bone stock, which makes biological fixation difficult.
In terms of implant survival rates, both cementless and modern cemented implant options have been demonstrating good results. However, even after adjusting for patient age, surgeon skill, and the implantation term, cementless fixations tend to have slightly higher revision rates than the cemented method, as published in a February 2017 meta-analysis conducted by Phedy P. et al. The paper evaluated 27 previously conducted clinical studies, including randomized clinical trials cohorts and joint registers.
Many surgeons prefer to use cementless hip implants, as they believe press-fitted implants are more durable over the long-term. One of the main disadvantages of using bone cement relates to its possible degradation over time, which can lead to implant loosening. The cement can also cause inflammation of the soft tissue adjacent to the implant site. The use of cementless components in hip arthroplasty also allows for reduced total surgical time, which is desirable to surgeons and healthcare facilities, as minimizing operating room time reduces overall procedure costs.
While the cementless method had taken over much of the cemented hip implant market in the past, reaching over 50 percent of procedures performed, that transition has appeared to stop. Cementless and cemented implants will remain the significant methods between 2017 and 2024, but are seeing minimal growth and will become less important as European orthopedic surgeons realize the potential of hybrid methods.