Search Results (2,492)

Background: Ketoprofen is one of the most commonly prescribed NSAIDs; however, its pharmacogenetics remains poorly understood. The objective was to evaluate the influence of patients’ pharmacogenetic profiles on the effectiveness of ketoprofen for postoperative pain management after total hip arthroplasty, including postoperative analgesia (pain levels, opioid consumption) and the incidence of adverse reactions during hospitalization and up to 12 months post-surgery. Methods: The study included 53 patients (31 (58.49%) women, median age 66.0 [60.0–74.0] years) undergoing total hip arthroplasty. Genotyping was performed using real-time PCR to analyze 18 single-nucleotide polymorphisms (SNPs) across the following genes: CYP2C9 (rs1799853, rs1057910), CYP2C8 (rs10509681, rs11572080), CYP3A4 (rs35599367), CYP3A5 (rs776746), UGT2B7 (rs73823859, rs7439366, rs7668282), ABCB1 (rs1045642, rs4148738, rs2032582, rs1128503), PTGS1 (rs10306135, rs12353214), PTGS2 (rs20417), C3orf20 (rs12496846), and ZNF493-ZNF429 (rs2562456). Results: We did not find significant associations between patients’ genotypes and pain levels or postoperative opioid analgesic consumption or adverse reactions when ketoprofen was used for pain management in patients undergoing total hip arthroplasty. Conclusions: Routine pharmacogenetic testing for ketoprofen is not supported by our findings. Full article

Background/Objectives: Coronal Plane Alignment of the Knee (CPAK) classification enables individualized alignment assessment in total knee arthroplasty (TKA), yet manual evaluation is time-consuming and lacks preoperative-to-postoperative transition analysis. Methods: This retrospective, single-center study aimed to develop and validate a fully automated deep learning-based CPAK classification system using internal validation on a held-out test set (n = 92) and to investigate individual-level transition patterns and their association with short-term clinical outcomes using paired radiographic data from a large Chinese cohort. A total of 919 KOA patients undergoing TKA were analyzed. A keypoint detection model (HRNet-W32) was developed to automatically calculate the medial proximal tibial angle, lateral distal femoral angle, arithmetic hip-knee-ankle angle, and joint line obliquity, from which CPAK types were derived. Results: On the validation set (92 cases), the model achieved a Mean Radial Error of 1.22 ± 0.43 mm for keypoint detection; mean absolute errors for MPTA and LDFA were ≤0.74°, while for aHKA and JLO they were 0.91° and 1.12°, respectively, with intraclass correlation coefficients ≥0.96 compared to manual annotations. Automatic CPAK classification accuracy was 80.98% (kappa = 0.767). Transition matrix analysis showed that only 9.36% of all patients maintained their original type postoperatively, with most shifting to types IV, V, or VII. After inverse probability weighting, no significant differences in clinical outcomes were observed among transition groups (all adjusted p > 0.05). Conclusions: These results demonstrate that the proposed automated system enables efficient CPAK assessment, revealing substantial postoperative alignment transitions that were not associated with differential short-term outcomes, thereby supporting AI-assisted individualized alignment planning in TKA. Full article

Purpose: To evaluate the accuracy and precision of both femoral and tibial bone resections in unrestricted kinematic alignment total knee arthroplasty (uKA TKA) performed with manual instrumentation, using postoperative digital caliper measurements. Methods: A retrospective study analyzing prospectively collected data on femoral and tibial resection thickness in 73 patients undergoing primary uKA TKA. Femoral cuts were performed with manual KA-optimized instrumentation in all cases. Tibial cuts were performed manually in 58 cases and with patient-specific instrumentation (PSI) in 15; PSI tibial resections were excluded from tibial analyses. Postoperatively, resection thickness was measured using a digital vernier caliper (0.2 mm resolution) at predefined sites: distal medial femur (DMF), distal lateral femur (DLF), posterior medial femur (PMF), posterior lateral femur (PLF), medial tibial plateau (MTP), and lateral tibial plateau (LTP). Resection error was defined as measured minus target thickness (mm). Accuracy was reported as mean signed error; precision as SD of signed error; absolute errors and error class distributions were also reported. Postoperative measurements reflect the accuracy and precision of the initial manual tibial resections, excluding any subsequent corrective cuts. Results: A total of 408 measurements were analyzed (292 femoral, 116 tibial). Mean signed error across resections was low and consistently negative (−0.15 to −0.31 mm), with infra-millimetric precision (SD 0.45 to 0.73 mm). Mean absolute errors remained low across sites (0.35 to 0.62 mm). The proportion of errors outside ±0.5 mm ranged from 21.1% (PLF) to 44.4% (LTP) and those outside ±1.0 mm from 1.4% (DMF) to 18.5% (LTP). No errors exceeded ±2.0 mm. Conclusions: Manual caliper-verified unrestricted KA TKA achieved high accuracy and precision for both femoral and tibial resections. However, these findings do not establish superiority over other techniques and do not account for final implant position, soft-tissue balance, or clinical outcomes. This study provides quantitative data on tibial resection accuracy in uKA TKA and may serve as a benchmark for evaluating the performance of technology-assisted techniques. Full article

Staphylococcus aureus biofilms formed on titanium surfaces are highly relevant to orthopedic implant-associated infection and remain difficult to control after maturation. This study aimed to evaluate whether ultraviolet A (UVA, 365 nm) combined with cinnamaldehyde (CA) could improve antibiofilm activity against titanium-associated S. aureus biofilms in a stage-resolved in vitro model and to examine whether the observed responses were associated with reactive oxygen species (ROS). Early stage (8 h) and 24 h biofilm models were established on total hip arthroplasty (THA)-derived titanium discs. After condition screening, 0.5 mM CA combined with 5 min UVA exposure was selected for subsequent experiments. Biofilm biomass was assessed by crystal violet staining, bacterial viability by live/dead staining and colony-forming unit (CFU) enumeration, ROS-associated fluorescence by dihydroethidium (DHE) imaging, and biofilm-associated gene expression by quantitative real-time PCR (qRT-PCR). Chondrocyte viability was also evaluated under the selected antibiofilm-effective conditions. The combined treatment showed stage-dependent antibiofilm effects, with greater biomass reduction in the 8 h biofilm model and marked impairment of bacterial viability and culturability in both models. ROS-associated fluorescence increased under combined exposure and was partially attenuated by N-acetyl-L-cysteine (NAC) in the 24 h biofilm model. In parallel, CA + UVA was associated with lower expression levels of clfA, icaA, and icaD in the 8 h biofilm model and of icaA, icaB, and icaD in the 24 h biofilm model, with partial NAC attenuation in the latter. Chondrocyte viability was lower in all treatment groups than in the untreated control, although the combined treatment did not show an obvious additional decrease compared with the single-treatment groups. These findings indicate that UVA combined with CA exerts stage-dependent antibiofilm effects in an in vitro titanium-associated S. aureus biofilm model. The observed ROS-associated responses were consistent with, but do not establish, mechanistic involvement. The current treatment setting also requires further optimization before translational applicability can be more confidently considered. Full article

Background: Recovery following total joint arthroplasty varies substantially among patients, and psychological factors may partly account for this variability. Although anxiety and depression have been widely investigated, the specific contribution of preoperative surgical fear to postoperative pain and quality of recovery remains unclear. This study aimed to examine the association between preoperative surgical fear and postoperative pain intensity and quality of recovery. Methods: This prospective, hospital-based observational study enrolled 89 patients undergoing primary total knee or hip arthroplasty. Preoperative surgical fear was measured using the Surgical Fear Questionnaire (SFQ). Pain intensity was assessed with the Numeric Rating Scale (NRS) preoperatively and at three postoperative time points. Recovery quality at 24 h was evaluated using the Quality of Recovery-40 (QoR-40). Pearson correlation and multiple linear regression analyses were performed to evaluate associations and identify variables independently associated with recovery outcomes, controlling for potential confounders, including age, sex, ASA physical status, and type of surgery. Results: The mean SFQ score was 26.62 ± 15.19, and the mean QoR-40 score was 157.63 ± 16.66. Surgical fear was moderately and negatively correlated with overall recovery quality (r = −0.546, p < 0.001). In multiple linear regression analysis, surgical fear was most strongly associated with poorer overall recovery quality (β = −0.563, p < 0.001), within a model explaining 30.3% of the variance (adjusted R² = 0.303). At the subscale level, surgical fear was significantly associated with emotional state, pain, physical comfort, and perceived support. Pain intensity at 12 h postoperatively was significantly associated with reduced physical independence (β = −0.218, p = 0.038). Pain intensity peaked at 12 h postoperatively (p < 0.001). Conclusions: Higher levels of preoperative surgical fear are associated with poorer quality of recovery following total joint arthroplasty. These findings highlight surgical fear as a potentially relevant perioperative factor and support the integration of routine psychological assessment into perioperative care pathways in relation to early postoperative recovery outcomes. From a clinical perspective, early identification of patients with high surgical fear may facilitate targeted perioperative counseling and supportive interventions by healthcare professionals, potentially improving recovery outcomes. Full article

Background: Peri-prosthetic joint infection (PJI) following total knee arthroplasty complicated by soft tissue compromise presents a major reconstructive challenge. Successful management requires the eradication of infection while restoring durable soft tissue coverage and limb function. This study reports the outcomes of a patient-specific, multidisciplinary orthoplastic approach to complex knee PJI. Methods: We retrospectively reviewed five patients with complex infected knee arthroplasty and associated soft tissue compromise managed at our institution between 2021 and 2025 by a single orthopaedic surgeon and two plastic reconstructive surgeons. All cases required personalized management, including the use of custom spacers, patient-specific orthopaedic reconstruction, and individualized soft tissue reconstruction techniques. Data collected included patient demographics, infection characteristics, reconstructive techniques, and functional outcomes. Results: All patients achieved durable soft tissue coverage and infection eradication at final follow-up. Of the five patients, one underwent primary closure of a persistent sinus, one required a local axial bi-pedicled flap for sinus control and soft tissue closure, two were managed with medial gastrocnemius flaps, and one complex case with an associated bone defect required a custom-designed spacer to achieve stability and dead-space management. Conclusions: In this retrospective case series, we aim to demonstrate that complex knee PJI with associated soft tissue defects may be successfully managed with an individualized, multidisciplinary strategy. We aim to demonstrate the feasibility of such an approach in a tertiary referral centre and to highlight the importance of customisation in achieving infection control and limb preservation. Full article

Background/Objectives: Interscalene brachial plexus block (ISB) is a common regional anesthesia technique for analgesia in patients undergoing shoulder surgery. Liposomal bupivacaine (LB) was developed to prolong analgesia duration; however, the existing literature demonstrates mixed results regarding its efficacy. This study aimed to compare the analgesic effectiveness of near-equipotent doses of LB and plain bupivacaine (PB) for patients undergoing total shoulder arthroplasty (TSA). Methods: This prospective double-blinded randomized controlled trial enrolled 78 elective TSA patients. Participants were randomized to receive an ISB with either 36 mL of 0.5% PB (180 mg) or a mixture of 10 mL of LB, 20 mL of 0.25% PB, and 6 mL of saline (183 mg). The primary outcome was the proportion of patients with clinically tolerable pain scores (visual analog scale (VAS) ≤ 4) on postoperative day (POD) 1 in each group. Secondary outcomes included the proportion of patients with clinically tolerable pain scores on POD 2–5, overall pain scores in the post-anesthesia care unit (PACU) and on POD 1–5, Quality of Recovery Survey-15 (QoR-15) scores on POD 1–5, analgesic consumption on the day of surgery and on POD 1–5, and adverse events. Results: A total of 67 patients completed the study. There was a statistically significant increase in median body mass index (BMI) in the PB vs. LB group (30.0 (27.4–33.1) vs. 27.0 (24.3–29.4), p = 0.0197). All other demographic characteristics were comparable between groups. There was no difference in the primary outcome or any of the secondary outcomes. Conclusions: LB did not reduce postoperative pain compared to PB. Larger, multicenter studies are warranted to further evaluate the clinical benefit of LB in this population. Full article

Purpose: The treatment of proximal humerus fractures (PHFs) remains debated, and similar fracture patterns may be managed with different strategies. The aim of this retrospective single-center case series without a control group was to evaluate clinical and radiographic outcomes after treatment of selected PHFs with the Galaxy Fixation System. The primary endpoint was functional recovery at 12 months, assessed using the Constant Shoulder Score and QuickDASH. Secondary endpoints included radiographic maintenance of reduction, quality of life, treatment-related complications, and need for revision surgery. Methods: We retrospectively analyzed 48 consecutive patients with proximal humeral fractures treated at the Orthopaedic and Traumatology Unit of Versilia Hospital, Viareggio, Italy, between November 2017 and February 2022. Fractures were assessed using trauma-series radiographs and computed tomography when required, and were classified by two senior surgeons according to the Neer, AO/OTA, and Hertel classifications. Eligible patterns included 2-part, 3-part, and selected 4-part fractures with at least two-thirds of intact metaphyseal bone stock. Results: Forty-six patients completed the 12-month follow-up; two patients died during follow-up from causes unrelated to the index procedure. The mean Constant Shoulder Score improved from 62.7 at 6 months to 69.3 at 12 months, and the mean QuickDASH improved from 9.4 to 8.1. The mean postoperative head-shaft angle was 137.2 degrees and remained substantially stable at 135.1 degrees at 12 months. Pin-tract infection occurred in 5 patients, pin migration in 4, algodystrophic syndrome in 1, and avascular necrosis requiring revision arthroplasty in 1. Conclusions: In this retrospective uncontrolled series, external fixation with the Galaxy system was associated with progressive functional recovery, satisfactory radiographic maintenance of reduction, and a low rate of revision surgery in carefully selected PHFs. These findings should be interpreted cautiously because of the retrospective design, limited sample size, absence of a control group, incomplete availability of some baseline variables, and lack of formal comparative or cost-effectiveness analyses. Full article

Background/Objectives: To evaluate the short-term clinical and radiological outcomes of using custom-designed additive-manufactured acetabular components (CDAMACs) in revision total hip arthroplasty for patients with Paprosky type IIIA-IIIB acetabular defects. Materials and Methods: A retrospective single-center case series was conducted. Between 2020 and 2025, 19 patients with massive Paprosky type IIIA-IIIB acetabular defects underwent revision hip arthroplasty with CDAMACs. Preoperative planning was based on multislice computed tomography data, followed by 3D modeling and implant design. Perioperative parameters, functional outcomes (Harris Hip Score [HHS], WOMAC, Visual Analog Scale [VAS] for pain), and radiographic parameters (restoration of the center of rotation, component stability) were assessed. Minimum follow-up was 12 mo. Results: The mean operative time was 155 ± 24 min, and the mean blood loss was 718 ± 288 mL. At 12 mo, significant functional improvements were observed: the mean HHS increased from 37.5 ± 5.2 to 74.5 ± 8.6 points, WOMAC decreased from 74.5 ± 9.2 to 40.3 ± 7.6 points, and VAS decreased from 7.6 ± 1.0 to 2.8 ± 0.7 points (p < 0.001 for all). Restoration of the hip center of rotation was determined. Minimum follow-up was 12 mo. No component migration or progressive radiolucent lines were observed. Complications occurred in two patients (10.5%), with only one case directly related to the acetabular component. Conclusions: The use of CDAMACs in revision hip arthroplasty for severe Paprosky type IIIA-IIIB acetabular defects is associated with satisfactory short-term clinical, functional, and radiological outcomes. This technique enables restoration of the center of rotation and provides stable component fixation in complex anatomical conditions. Full article

(1) Background: Megaprosthetic reconstruction of the knee is frequently required in limb salvage surgery for oncologic indications and in complex revision arthroplasty. The Modular Universal Tumor and Revision System (MUTARS) Total Knee prosthesis is widely used in these situations. The aim of this study was to evaluate revision-free implant survival following MUTARS Total Knee implantation and to compare outcomes between primary implantation and use as a conversion procedure after failure of a previous knee prosthesis. (2) Methods: A retrospective cohort study was performed including 36 patients who underwent MUTARS Total Knee implantation at a single institution. Patients were stratified into primary implantation (n = 24) and conversion after failed prosthesis (n = 12). The primary endpoint was time to first revision. (3) Results: Overall revision-free survival was 51.6% at 2 years and 29.3% at 5 years. No significant difference in revision-free survival was observed between primary implantation and conversion procedures (log-rank p = 0.67). When mechanical failure (Henderson type III) was considered as the sole endpoint, implant survival was substantially higher, with 88.3% survival at 2 years and 57.2% at 5 years. Infection-related implant survival was 72.0% at both 2 and 5 years. Secondary amputation was required in 7 of 36 patients (19.4%), with a higher proportion observed in the primary implantation group (25.0% vs. 8.3%). Most amputations occurred within the early postoperative period. (4) Conclusions: MUTARS Total Knee implantation is associated with a substantial revision burden; however, conversion after failed prosthesis did not result in inferior revision-free survival compared with primary implantation. Endpoint-specific analyses demonstrate that biological complications, particularly infection, represent the dominant drivers of early failure. Full article

Background: Medial-compartment knee osteoarthritis (KOA) carries substantial disability and long-term cost. High tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are key joint-preserving or joint-replacing options for selected patients, but their comparative economic ranking remains uncertain. Methods: This critical narrative review synthesized comparative economic evidence on HTO versus UKA for isolated medial-compartment KOA. PubMed and Web of Science were searched as primary sources for English-language studies published from 1 January 2000 to 15 January 2026, while Google Scholar and citation tracking were used supplementarily to identify potentially missed records. Eligible studies were direct economic evaluations or comparative cost/resource studies with clear decision relevance to the HTO–UKA choice. Burden and cost-of-illness studies were used for contextual framing only and were not included in the core comparative synthesis. Results: The direct evidence base was small and methodologically heterogeneous and was dominated by decision-analytic models that differed in perspective, time horizon, utility metric, and assumptions regarding reoperation, revision, and conversion to total knee arthroplasty (TKA). These structural differences largely explain why a U.S. lifetime societal model favored HTO, a UK age-stratified 10-year model produced age-dependent findings, and a recent Canadian public-payer model favored UKA. Observational studies suggest that UKA episode costs can fall substantially in outpatient or ambulatory pathways, whereas HTO costs may rise when reoperations and technique-specific resource use are explicitly captured. Conclusions: Current evidence does not support a context-free economic ranking of HTO and UKA. Because the available studies are heterogeneous and incremental utility differences are often small, the findings should be interpreted cautiously and as scenario-dependent rather than definitive. Future comparative analyses should use contemporary pathway data, transparent and standardized costing, and explicit downstream event definitions for both procedures. Full article

Osteoarthritis is a leading cause of lower-limb arthroplasty, and although total hip arthroplasty (THA) and total knee arthroplasty (TKA) reduce pain and improve quality of life, gait impairments often persist after surgery. This study aimed to analyze gait patterns in individuals following THA and TKA using the wearable RunScribe™ sensor system and to examine its sensitivity to short-term changes during rehabilitation. Thirty-seven patients (19 THA, 18 TKA) attending a two-week inpatient rehabilitation program were assessed twice, on the first and final day of rehabilitation. Gait was measured during a 2 min circular walk test, and both global spatiotemporal variables and limb-specific loading-related variables were analyzed. A significant main effect of time was observed for walking speed (p = 0.001, ηp² = 0.284), with improvements of approximately 10% in both groups, as well as for step cadence (p < 0.001, ηp² = 0.429) and contact time (p < 0.001, ηp² = 0.380). Loading-related variables also changed significantly over time, including impact acceleration (p = 0.004, ηp² = 0.226), braking acceleration (p < 0.001, ηp² = 0.419), and rate of force development (p < 0.001, ηp² = 0.412). No statistically significant between-group differences were observed for global gait variables, although participants following THA showed a tendency toward better walking performance (e.g., higher cadence, p = 0.065). These findings suggest that early rehabilitation is associated with measurable improvements in gait after arthroplasty and support the potential of affordable wearable sensors as practical tools for objective gait assessment in clinical settings. Full article

Background: Total knee arthroplasty (TKA) is a common procedure aimed at alleviating knee pain and restoring function in patients with degenerative joint diseases. Traditional implants are typically designed to restore mechanical knee alignment, but personalized implants have shown promise in improving clinical outcomes. The Origin^® individualized TKA system provides a tailored approach to knee reconstruction by utilizing preoperative 3D planning to create individualized implants and cutting guides based on each patient’s unique anatomy. Surgical Technique: The Origin^® system employs a preoperative computed tomography (CT) scan and Knee-Plan^® software to design individualized implants that optimize alignment and joint anatomy. The surgical technique involves the use of patient-specific cutting guides for precise bone resections and the insertion of either cruciate-retaining (CR) or posterior-stabilized (PS) implants, depending on individual patient needs. This process aims to replicate the pre-arthritic alignment and kinematics of the pre-arthritic knee. Postoperative Protocol: The postoperative protocol allows for immediate weight-bearing, and patients are guided through a structured rehabilitation program to ensure optimal recovery. Full range-of-motion exercises begin early to promote knee mobility and strength. Discussion: The individualized TKA system offers several advantages, including precise restoration of pre-arthritic anatomy, reduced bone resection, and improved implant fit. These benefits are particularly valuable in patients with unique anatomical challenges, such as deformities or previous surgeries. Despite the potential advantages, challenges remain, including the costs and time associated with individualized manufacturing, as well as increased radiation exposure from the required CT scans. Conclusions: The Origin^® individualized TKA system represents a significant advancement in knee arthroplasty by providing a tailored approach to patient care. Future studies are needed to further evaluate the long-term outcomes and cost-effectiveness of this personalized system compared to conventional TKA approaches. Full article

Background and Objectives: High rates of mortality and morbidity among elderly hip fracture patients are a recognized global issue. This study aimed to evaluate risk factors for early complications and 30-day mortality in hip fracture patients. Materials and Methods: The prospective study included 583 patients over 65 years old who sustained hip fractures from fall and underwent surgery. Each patient was followed up for 30 days and complications were recorded. Regression models were used to assess the influence of patient characteristics and laboratory markers on 30-day mortality and complications. Results: Any complication increased the risk of mortality by 5.6 times (95% CI 1.6–19.9, p = 0.008). Having > 6 comorbidities increased the risk of mortality by 8.2 (95% CI 1.9–35.5, p = 0.005) and the risk of complications by 2.3 (95% CI 1.9–35.5, p = 0.000). Patients > 85 years old had increased risk of mortality by 2.2 times (95% CI 1.2–4.1, p = 0.015) and a 1.7-fold increase in risk of complications (95% CI 1.2–2.4, p = 0.005). Vitamin D significantly predicted mortality with odds ratio of 2.1 (95% CI 1.1–4.1, p = 0.028). Serum N-terminal pro-brain natriuretic peptide levels > 780 ng/L predicted 2.3-fold increase in mortality (95% CI 1.0–4.9, p = 0.040) and a 2.6-fold risk of complications (95% CI 1.7–3.9, p = 0.000). Conclusions: Occurrence of complication increases the risk of mortality. Age and comorbidities are significant factors associated with 30-day mortality and complications. Vitamin D levels are associated with higher risk of mortality. N-terminal pro-brain natriuretic peptide levels correspond to higher risks of death and complications. Full article

Background: Cemented and cementless fixation techniques in total hip arthroplasty (THA) each present distinct biomechanical properties and perioperative risk profiles. While cementless fixation has gained increasing popularity, large-scale nationally representative comparisons of perioperative outcomes between cemented and cementless elective THA remain limited. This study aimed to compare complication rates, healthcare utilization, and temporal trends between cemented and cementless elective THA using the National Inpatient Sample. Methods: A retrospective cohort study was conducted using the National Inpatient Sample database from 2016 to 2021. Adult patients undergoing elective primary total hip arthroplasty were identified using ICD-10-PCS codes and categorized into cemented and cementless fixation groups. Patient demographics, comorbidities, indications, postoperative complications, length of stay, hospital charges, and in-hospital mortality were compared. Multivariate logistic regression analysis was performed to evaluate the independent association between fixation type and postoperative complications while adjusting for demographic, clinical, and hospital-level variables. Results: A total of 81,668 elective THAs were identified, including 40,290 cemented (49.33%) and 41,378 cementless (50.67%) procedures. Cemented THA was associated with a shorter length of stay (2.09 ± 1.88 vs. 2.26 ± 2.47 days, p < 0.001) and lower total hospital charges ($65,584.53 ± 48,797.21 vs. $72,186.84 ± 49,860.20, p < 0.001). Unadjusted analyses demonstrated higher rates of acute kidney injury and sepsis in the cementless group. After multivariate adjustment, cemented fixation was associated with lower odds of acute kidney injury (OR 0.87, 95% CI 0.79–0.96, p = 0.004). However, cemented THA was associated with higher odds of postoperative delirium (OR 1.20, 95% CI 1.02–1.42, p = 0.030), blood transfusion (OR 1.27, 95% CI 1.17–1.37, p < 0.001), and periprosthetic fracture (OR 1.32, 95% CI 1.02–1.71, p = 0.035). Rates of myocardial infarction, pneumonia, venous thromboembolism, urinary tract infection, and in-hospital mortality were similar between groups. Temporal analysis demonstrated comparable utilization trends, with a decline in elective procedures during 2020–2021. Conclusions: In this nationwide analysis, cemented total hip arthroplasty was associated with lower risk of acute kidney injury, shorter length of stay, and lower hospital charges, but higher odds of postoperative delirium, blood transfusion, and periprosthetic fracture compared with cementless fixation. These findings highlight distinct perioperative risk profiles between fixation strategies and may assist surgeons in individualized decision-making for elective total hip arthroplasty. Full article