Since the introduction of the first modern hip implants in
the 1960s, total hip arthroplasty (THA) and hemiarthroplasty (HA) have
continued to evolve towards minimizing implant-related complications.
Developments in surgical techniques and anaesthesiological methods have also
made the procedure safer for patients.

Cementing is the gold standard for implant fixation,
especially in elderly patients in both elective surgery for osteoarthritis (OA)
and facture surgery due to femoral neck fracture. Lower revision rates for
cemented implants in elderly patients has been found in all major registries
compared to uncemented implants. In addition, national guidelines in several
countries recommend cemented HA in femoral neck fracture. However, earlier in
the development of THA it was thought that cemented hip arthroplasty is
associated with higher peri- and post-operative mortality compared to
uncemented hip arthroplasty due to bone cement implanting syndrome (BCIS),
especially in fracture surgery.

In THA, dislocation is the second most common reason for
revision surgery in Finland. Both patient-related and surgical factors may
predispose to THA dislocation. Large-diameter head (LDH) metal-on-metal (MoM)
THA and hip resurfacing arthroplasty (HRA) were developed to address this
problem. However, these devices have their own unique problems, and increased
risk of cancer has been suggested to be related to the metal particles
resulting from corrosion and wear of MoM hip implants.

The main aims of this doctoral thesis were 1) to determine
the mortality associated with the use of bone cement in THA and HA, especially
during and immediately after surgery; 2) to investigate the risk of cancer in
patients with MoM hip devices; and 3) to examine the predisposing factors for
revision for dislocation after primary THA. This thesis is based on
observational registry studies gathering information from the Finnish Arthroplasty
Register (FAR), Finnish Cancer Register, the PERFECT database of the National
Institute for Health and Welfare in Finland and the electronic patient record system
at Turku University Hospital.

In this study, we found no statistically significant
difference in early postoperative mortality when using bone cement in THA or
HA. With MoM hip implants no increase in the overall risk of cancer was
detected during midterm follow-up. However, the risk of basalioma was higher in
the MoM cohort than in the general Finnish population and in patients with
other bearing surfaces. Posterior approach, fracture diagnosis and American
Society of Anesthesiologists (ASA) class III–IV were found to be associated with
increased risk of revision due to dislocation after total hip arthroplasty.