Operative Outcomes of Cemented Hip Arthroplasty: An Examination of the French Paradox.

BACKGROUND: The benefits of cemented total hip arthroplasty continue to be recognized. Different methods of cement fixation exist, including the "French Paradox" which utilizes a line-to-line cement mantle. This study evaluated the postoperative outcomes of a cemented femoral stem using the "French Paradox" method.

METHODS: In this retrospective cohort study, patients who underwent hip arthroplasty using a single femoral stem system with a wedge-taper design were identified using electronic medical records at a single academic institution from 2013 to 2020. The French Paradox technique was utilized for patients undergoing cement fixation. The outcomes reviewed were implant failure rates, including the mechanism of failure, subsidence (mm), evidence of aseptic loosening, intraoperative fractures, and bone cement implantation syndrome. Standard statistical analysis was performed for the 529 patients who met inclusion criteria; 227 were cemented and 302 were uncemented stems.

RESULTS: Readmission rates at 90 days for cemented and uncemented stems were 0.18 and 0.16, respectively (Chi-square 0.12, P = 0.71). The average subsidence (mm) in cemented and uncemented stems was 3.71 and 5.16 (P < 0.0001), respectively. There were 22 and 33 intraoperative fractures in the cemented and uncemented groups, respectively (Chi-square 0.40, P = 0.53). There were four postoperative periprosthetic fractures in the cemented group and ten in the uncemented group (Chi-square 1.21, P = 0.27).

CONCLUSION: This study demonstrated that wedge-tapered stems using the French Paradox cement technique resulted in low failure rates and minimal subsidence, similar to what is reported in the literature. This study is the largest and sole investigation of its kind to reinforce the utility of wedge-taper stems with a French Paradox cement technique.