Early Postoperative Inflammatory Response After Total Hip Arthroplasty: Standard Cement, Pre-Chilled Cement, and Cementless Fixation

Background: This non-randomized, observational study compared early postoperative inflammation in total hip arthroplasty using standard polymethyl methacrylate cement, pre-chilled polymethyl methacrylate cement, and cementless fixation. Methods: 72 patients (mean age 66.9 ± 8.8) undergoing total hip arthroplasty were divided into three groups (n = 24 each): standard antibiotic-loaded polymethyl methacrylate cement, pre-chilled polymethyl methacrylate cement, and cementless fixation. Serum interleukin-6, tumor necrosis factor-alpha, C-reactive protein, and erythrocyte sedimentation rate were measured preoperatively and 24 h postoperatively. Results: All biomarkers increased significantly after surgery (p < 0.001). Postoperative levels were significantly higher in both cemented groups versus the cementless group (p < 0.001). No significant differences were observed between the standard and pre-chilled groups for most markers. Conclusions: Cemented arthroplasty was associated with higher early systemic inflammation than cementless fixation, although these differences were heavily confounded by baseline characteristics, including older age, poorer bone quality, and greater comorbidity burden. Addressing limited comparative data on pre-chilled PMMA cement, this prospective observational pilot study found no significant reduction in systemic inflammatory markers with pre-chilling, although local thermal protection cannot be excluded. Only biochemical markers were evaluated; no clinical endpoints were assessed. Consequently, no clinical conclusions can be drawn, and the findings are hypothesis-generating with limited current translational impact.