Matched-pair analysis of cemented and cementless acetabular reconstruction in primary total hip arthroplasty. Second-Generation Cementless Total Hip Arthroplasty: Eight to Eleven-Year Results Osteolysis in cemented versus cementless acetabular components. A constrained liner cemented into a secure cementless acetabular shell. Results of Porous-Coated Anatomic Total Hip Arthroplasty without Cement at Fifteen Years: A Concise Follow-up of a Previous Report* The Nicolas Andry Award: Comparative Results of Cemented and Cementless Total Hip Arthroplasty Early radiographic results comparing cemented and cementless total hip arthroplasty. Cemented polyethylene and cementless porous-coated acetabular components have similar outcomes at a mean of seven years after total hip replacement: a prospective randomised study. Primary Total Hip Arthroplasty with a Second-Generation Cementless Total Hip Prosthesis in Patients Younger Than Fifty Years of Age Hybrid Total Hip Arthroplasty with a Precoated Offset Stem: Four to Nine-Year Results* Prospective study of a cementless total hip arthroplasty with a collum femoris preserving stem and a trabeculae oriented pressfit cup: minimun 6-year follow-up Results of Charnley total hip arthroplasty at a minimum of thirty years. A concise follow-up of a previous report. Results of Charnley total hip arthroplasty with use of improved femoral cementing techniques. a concise follow-up, at a minimum of twenty-five years, of a previous report. Comparison of total hip replacement with and without cement in patients younger than 50 years of age: the results at 18 years. Arthopor 2 acetabular component with screw fixation in primary hip arthroplasty: a 7- to 9-year follow-up study. No Migration of Acetabular Cups after Prophylaxis for Heterotopic Ossification Hydroxyapatite in Total Hip Arthroplasty: Clinical Results and Critical Issues A randomised prospective evaluation of ceramic-on-ceramic and ceramic-on-highly cross-linked polyethylene bearings in the same patients with primary cementless total hip arthroplasty Precoated femoral component in total hip arthroplasty. Results of 5- to 9-year followup. The Porous Coated Anatomic Total Hip Replacement: A Ten to Fourteen-Year Follow-up Study of a Cementless Total Hip Arthroplasty Long term results of the Corin C-Fit uncemented total hip arthroplasty in young patients Comparison of total hip arthroplasty performed with and without cement: a randomized trial. A concise follow-up, at twenty years, of previous reports. Primary Total Hip Arthroplasty with a Porous-Coated Acetabular Component. Seven-to-Ten-Year Results*
In a matched-pair study of primary total hip arthroplasty , 45 all-polyethylene cemented acetabular components were compared with 45 cementless , hemispheric , titanium acetabular components .  At 9 to 12 years , 1 of the cemented acetabular components was revised for aseptic loosening , and 14 ( 31 % ) were radiographically loose . Nine ( 20 % ) cemented acetabular components had pelvic osteolysis . In the cementless acetabular component group , 2 well-fixed components were revised . No components were radiographically loose , and 3 ( 7 % ) had pelvic osteolysis . Thirty-eight ( 97 % ) of the patients in each group were satisfied with the surgery . The clinical results of the cemented and cementless components were excellent . The cementless components had less loosening ( P < .001 ) than the cemented components Background : Second-generation cementless femoral components were design ed to provide more reliable ingrowth and to limit distal osteolysis by incorporating circumferential proximal ingrowth surfaces . We examined the eight to eleven-year results of total hip arthroplasty with a cementless , anatomically design ed femoral component and a cementless hemispheric acetabular component . Methods : Ninety-two consecutive primary total hip arthroplasties with implantation of a femoral component with a circumferential proximal porous coating ( Anatomic Hip ) and a cementless hemispheric porous-coated acetabular component ( Harris-Galante II ) were performed in eighty-five patients . These patients were prospect ively followed clinical ly and radiographically . Six patients ( seven hips ) died and five patients ( seven hips ) were lost to follow-up , leaving seventy-four patients ( seventy-eight hips ) who had been followed for a mean of ten years ( range , eight to eleven years ) . The mean age at the time of the arthroplasty was fifty-two years . Results : The mean preoperative Harris hip score of 51 points improved to 94 points at the time of final follow-up ; 86 % of the hips had a good or excellent result . Thigh pain was reported as mild to severe after seven hip arthroplasties . No femoral component was revised for any reason , and none were loose radiographically at the time of the last follow-up . Two hips underwent acetabular revision ( one because of dislocation and one because of loosening ) . Kaplan-Meier survivorship analysis was performed with revision or loosening of any component as the end point . The ten-year survival rate was 96.4 % ± 2.1 % for the total hip prosthesis , 100 % for the femoral component , and 96.4 % ± 2.1 % for the acetabular component . Radiolucencies adjacent to the nonporous portion of the femoral component were seen in sixty-eight ( 93 % ) of the -seventy-three hips with complete radiographic follow-up . Femoral osteolysis proximal to the lesser trochanter was noted in four hips ( 5 % ) . No osteolysis was identified distal to the lesser trochanter . Periacetabular osteolysis was identified in twelve hips ( 16 % ) . Five patients underwent exchange of the acetabular liner because of polyethylene wear . Conclusions : This second-generation cementless , anatomically design ed femoral component provided excellent clinical and radiographic results with a 100 % survival rate at ten years . The circumferential porous coating of this implant improved ingrowth and prevented distal osteolysis at a mean of ten years after the arthroplasty A prospect i ve , r and omized , double-blind , clinical trial comparing cemented with cementless total hip arthroplasty  was performed to compare the prevalence and pattern of acetabular osteolysis . Both groups were similar before surgery . Acetabular components were metal-backed , titanium implants . Twenty-eight-millimeter modular femoral heads with titanium femoral stems were used . At a minimum 2-year and mean 4-year follow-up period ( range , 2 - 6 years ) , 224 patients had clinical and radiographic data available . There was no significant difference in the prevalence of acetabular osteolysis between cemented ( 5 % ) and cementless ( 9 % ) fixation . With or without cement , the use of a titanium femoral head led to osteolysis within a relatively short period after surgery in almost all of the cases , although this was not significant . The pattern of acetabular osteolysis was different . Progressive osteolysis occurred predominantly in acetabular zone 1 in the cemented group and zone 2 in the cementless group . Cementless fixation of acetabular components has been advocated in an attempt to minimize osteolysis that may occur in cemented total hip arthroplasty . This study found no difference in the prevalence of acetabular osteolysis between the two groups BACKGROUND Constrained acetabular components have been used to treat hips with recurrent instability following total hip arthroplasty and hips that demonstrate instability during revision surgery . In such hips , when a secure cementless acetabular shell is present , the surgeon can cement a constrained liner into the existing shell . The purpose of this study was to evaluate the clinical and radiographic outcome of this technique with use of a tripolar constrained liner that was cemented into a well-fixed cementless acetabular shell . METHODS Between 1988 and 2000 , constrained liners were cemented into thirty-one well-fixed cementless acetabular shells  at three centers . The average age of the patients at the time of the index surgery was 72.1 years , and the indications for the procedure were recurrent hip instability in sixteen hips and intraoperative instability in fifteen hips . The patients were evaluated with respect to the clinical outcome and radiographic evidence of shell loosening and osteolysis . RESULTS At an average duration of follow-up of 3.9 years , twenty-nine liners ( 94 % ) were securely fixed in the cementless shells and two constrained liners had failed . One liner failed because it separated from the cement , and one failed because of fracture of the capturing mechanism . Both hips were successfully revised with another cemented tripolar constrained liner . No acetabular component demonstrated radiographic evidence of progressive loosening or osteolysis . CONCLUSIONS A constrained tripolar liner cemented into a secure , well-positioned cementless acetabular shell provides stability and durability at short-term follow-up . Careful attention to the preparation of the liner , the sizing of the component , and the cementing technique are likely to reduce the failure of this construct , which can be used for difficult cases of total hip instability Abstract : The purpose of this study was to up date the results of a prospect i ve series of primary cementless total hip arthroplasties  after a minimum of fifteen years of follow-up . It is one of the first studies of cementless total hip arthroplasties followed for a minimum of fifteen years . One hundred consecutive Porous Coated Anatomic ( PCA ) total hip replacements were implanted between October 1983 and January 1986 . Fifty-five patients ( sixty-four hips ) that were alive at a minimum of fifteen years postoperatively are the focus of the present study . At this time of follow-up , at an average of 15.6 years ( range , fifteen to seventeen years ) after the total hip arthroplasty , 17 % ( seventeen hips ) of the entire cohort and 23 % ( fifteen hips ) of the living cohort had undergone revision because of loosening of the acetabular component or osteolysis . Seven percent ( seven hips ) of the entire cohort and 6 % ( four hips ) of the living cohort had undergone revision for loosening of the femoral component or osteolysis . Only four femoral stems had been revised for isolated loosening ( without osteolysis).The  PCA femoral component proved to be durable at a minimum of fifteen years postoperatively , while the acetabular component was less durable . Level of Evidence : Therapeutic study , Level IV ( case series [ no , or historical , control group ] ) . See Instructions to Authors for a complete description of levels of evidence A prospect i ve r and omized clinical trial comparing cemented to cementless total hip arthroplasty  has been ongoing at the author 's institution since 1987 . All parameters assessed showed that there was no statistically significant difference in any of the health related quality of life measures used when patients with cement  were compared with patients without cement at any of the followup periods as many as 4 years later . The improvement was dramatic and sustained . No components ( cemented or cementless ) have been revised to date ( average , 4.8 years ) . A radiographic analysis showed probable loosening of the cemented socket in 24 % and presumed minimal pelvic osteolysis in 8 % . The cementless sockets showed a greater frequency and severity of pelvic osteolysis ( 14 % ) . The cemented femoral component was judged to be possibly loose in 10 % ; however , none were considered probably loose . The patients who had cementless femoral components were doing extremely well with the components showing very little subsidence or proximal stress protection noted . Osteolysis on the femoral side was not seen in any of the cementless stems . Total hip replacement gives comparable clinical results when health related quality of life measures are analyzed ; however , metal backed cemented acetabular components have a high rate of radiographic failure . Short-term stability of a non-cemented porous coated titanium stem , however , gave excellent clinical and radiographic results In a r and omized clinical trial of cemented and cementless total hip arthroplasty , 147 patients ( 76 cemented , 71 cementless ) have had a minimum 4-year clinical and radiographic follow-up evaluation . No revisions have been done in either group . Two cemented acetabular components were considered definitely loose and 18 were probably loose ; 7 cemented stems were possibly loose at last follow-up examination . One cementless socket was considered unstable . Although cementless femoral component subsidence occurred in 10 cases , the sinkage always stabilized within 6 months , and no stem was considered unstable at last follow-up examination . Significant femoral bone resorption was rare , and so-called " spot welds " were uncommon using this titanium stem .  Distal cortical hypertrophy was common , but the cause is uncertain . Osteolysis was seen around 10 cementless and 6 cemented sockets . A small area of lysis occurred in the proximal medial femoral neck in 15 cemented stems and 1 cementless stem . No cases of distal femoral lysis were seen in either group . Despite excellent clinical results with no difference between groups , the high rate of early radiographic failure of this metal-backed acetabulum should preclude its use . Osteolysis will continue to be a problem in both groups , and its prevention should remain the focus of future studies The aim of this prospect i ve r and omised study was to compare the clinical and radiological results of a cemented all-polyethylene Ultima acetabular component with those of a cementless porous-coated acetabular component ( PFC ) following  total hip replacement ( THR ) . A total of 287 patients received either a polyethylene acetabular component ( group A ) or a cobalt-chromium porous-coated component ( group B ) with an identical cemented femoral component and 28 mm cobalt-chromium head , thus making it the largest study of its type . Patients were evaluated radiologically and clinical ly using the Harris hip score ( HHS ) .  Group A comprised 183 patients ( 73 male , 110 female ) with a mean age of 71.3 years ( 55 to 89 ) . Group B comprised 104 patients ( 48 male , 56 female ) with a mean age of 69.8 years ( 56 to 89 ) . A total of 16 patients ( 13 in Group A , three in Group B ) did not have post-operative data for analysis . The mean follow-up in group A was 7.52 years ( 0.4 to 15.0 ) and in Group B 7.87 years ( 0.5 to 14.0 ) . At final follow-up the mean HHS was similar between groups A and B ( 74.5 ( 25 to 100 ) and 78.0 ( 37 to 100 ) , respectively ; p = 0.068 ) . The total number of revisions for any cause was 28 , 17 of which were in group A and 11 in group B. The ten-year survivorship was 86.8 % ( 95 % confidence interval ( CI ) 78.4 to 92.1 ) and 89.2 % ( 95 % CI 78.3 to 94.8 ) for groups A and B , respectively ( log-rank p-value = 0.938 ) . A total of 20 cemented and two cementless acetabular components had evidence of acetabular radiolucencies or acetabular component migration at last follow-up ( p = 0.001 ) . These results indicate that patients with a cemented all-polyethylene and cementless porous-coated polyethylene lined acetabular component have similar long-term clinical outcomes Background : The early experience with cementless total hip replacement led to design modifications to increase the initial press-fit and stability of the femoral component , to reduce the diameter of the femoral head , and to improve the acetabular component , including the locking mechanism of the shell and the quality of the polyethylene liner . We performed a prospect i ve study to assess the results in young patients who had been followed for a minimum of eight years after treatment with a primary total hip arthroplasty with a second-generation cementless prosthesis . Methods : Eighty patients ( 118 hips ) were included in the study . There were fifty-eight men and twenty-two women ; the mean age at the time of the operation was 46.8 years ( range , twenty-one to forty-nine years ) . We used a cementless Duraloc series-100 or 1200 acetabular component with or without screw fixation , a polyethylene liner with a 22-mm inner diameter , and a cementless Profile femoral component in all hips . The average duration of follow-up was 9.8 years ( range , eight to eleven years ) . Clinical follow-up ( with use of the Harris hip score ) and radiographic follow-up were performed at six weeks ; at three , six , and twelve months ; and yearly thereafter . Linear and volumetric wear were measured , and bone-remodeling and osteolysis were assessed . Results : The average Harris hip score improved from 48.8 points preoperatively to 92 points at the final follow-up examination . The prevalence of transitory thigh pain was 10 % ( twelve of 118 hips ) . There was no aseptic loosening . One hip was revised because of recurrent dislocation . The average amount of linear wear was 1.18 mm , and the average wear rate was 0.12 mm/yr . Fourteen hips ( 12 % ) had osteolysis in the calcar femorale and eleven hips ( 9 % ) had acetabular osteolysis , but all of the osteolytic lesions were < 1 cm 2 . Conclusions : The mechanical fixation of the anatomic fit cementless Profile stem was excellent in this study of young patients who were particularly difficult to treat because of a high prevalence of osteonecrosis and developmental dysplasia . Although there was no aseptic loosening of the components and a relatively low prevalence of osteolysis , there was a high rate of linear wear of the polyethylene liner . Level of Evidence : Therapeutic study , Level IV ( case series [ no , or historical , control group ] ) . See p. 2 for complete description of levels of evidence Background : Use of modern cementing techniques for fixation of femoral components in total hip arthroplasty has had excellent clinical and radiographic results in most patients . However , several authors have described early loosening of femoral components with roughened and precoated finishes . The purpose of this study was to examine the performance of the precoated Iowa stem , which has increased offset , and to compare the results with those of another cemented precoated femoral component with st and ard offset used at our institution . Methods : We carried out a prospect i ve analysis of 102 primary hybrid total hip arthroplasties ( a cementless acetabular component and a cemented femoral component ) performed with use of the Iowa femoral component in ninety-five patients at our institution . The Iowa stem was used in hips that required greater offset than is available with st and ard stems as determined by preoperative templating . The average age of the patients at the time of the index procedure was sixty-nine years . Sixteen patients ( seventeen hips ) died before the forty-eight-month minimum follow-up period had elapsed . Two patients were lost to follow-up , and radiographic follow-up was incomplete for one . The mean duration of clinical and radiographic follow-up of the remaining eighty-two hips in the seventy-six surviving patients was sixty-five months ( range , forty-eight to 104 months ) . Results : The average preoperative Harris hip score of 47 points ( range , 16 to 69 points ) improved to an average of 87 points ( range , 24 to 100 points ) at the time of the review . Two hips underwent femoral component revision . Four femoral stems were radiographically loose at an average of thirty-four months . Femoral osteolysis was seen in five hips ( 6 percent ) at an average of fifty-four months postoperatively . No acetabular component was revised because of aseptic loosening . According to Kaplan-Meier analysis , the seven-year survival rate , with an end point of femoral revision , osteolysis , or stem debonding , was 90.6 percent ( 95 percent confidence interval , 0.87 to 0.94 ) . Conclusions : The prevalence of revision , osteolysis , and loosening after total hip arthroplasty with the  Iowa femoral component  at our institution was higher than that seen in our series of Harris Precoat stems , which had a survival rate of 98.4 percent ( 95 percent confidence interval , 0.97 to 1.00 ) at ten years with the same end points . The design of the Iowa stem may make it difficult to achieve a good cement mantle , and , in combination with the geometry and increased offset of the stem , may compromise the long-term survival of this cemented femoral component Aim Tissue sparing hip prostheses are becoming more and more popular especially for the treatment of younger patients . The objective of this study was to evaluate the clinical and radiological results after insertion of a tissue sparing hip prosthesis . Method In 47 consecutive non-selected patients ( 50 hips ) , the clinical and radiographic results of cementless total hip arthroplasty using a collum femoris preserving stem , a pressfit cup and an alumina – polyethylene pairing were prospect ively evaluated . The mean age at index-surgery was 58 ( 36–82 ) years , there were 38 women and 9 men . After a mean follow-up of 6.8 years ( minimum 6.1 years ) , two patients had died and one patient underwent revision surgery due to aseptic loosening of the stem . Results The overall survival rate of the acetabular component was 100 % and of the femoral component 98 % . The mean Harris hip score at follow-up was 94 points . Conclusion The mid-term survival with this type of total hip arthroplasty is excellent and compares equal with uncemented straight stems in this age group The purpose of the current study was to up date the results of a prospect i ve , single-surgeon series of primary Charnley total hip arthroplasties performed with cement . This investigation is one of the first studies in which hips treated with total hip arthroplasty with cement  were followed for a minimum of thirty years . Twenty-seven patients ( thirty-four [ 10.3 % ] of the hips in the initial study group ) were alive at a minimum of thirty years postoperatively . These patients served as the focus of the present study .  Revision because of aseptic loosening of the acetabular component was performed in 7.3 % ( twenty-three ) of the hips from the original study group ( excluding those revised because of infection or dislocation ) and 26 % ( eight ) of the hips in the living cohort .  Revision  because of aseptic loosening of the femoral component was performed in 3.2 % ( ten ) of the hips from the original study group ( excluding those revised because of infection or dislocation ) and 10 % ( three ) of the hips in the living patients . Since the twenty-five-year review , three hips were revised ( one because of acetabular loosening , one because of femoral loosening , and one because of instability ) . This end- result study demonstrated the remarkable durability of cemented Charnley total hip replacements over a span of three decades , with 88 % of the original prostheses intact at the time of the final follow-up or at the patient 's death UNLABELLED The current study was performed to determine the status , at a minimum of twenty-five years , of a prospect i ve , single-surgeon series of patients treated with primary Charnley total hip arthroplasty with a contemporary femoral cementing technique that included use of a distal cement plug and a retro grade cement-delivery system . Since our review at a minimum of twenty years postoperatively , two primary total hip prostheses were revised ( one because of acetabular loosening , and one because of femoral loosening ) . Of the original cohort of 357 hips ( 320 patients ) , ten ( 2.8 % ) had revision of the femoral stem because of aseptic loosening . Forty-nine patients ( fifty-two hips , 14.6 % ) who had been in the initial study group were still living at the time of the present review . Five hips ( 10 % ) in living patients had required a femoral revision because of aseptic loosening . Including those that were revised , eight femoral components ( 17 % ) in living patients were seen to be loose radiographically . Although this study demonstrates the remarkable durability of the femoral fixation obtained with the polished flatback Charnley prosthesis and the contemporary cementing technique , there was some deterioration of the results with time . These results provide a st and ard for comparison with cementless fixation after hips treated with that technique have been followed for a similar duration . LEVEL OF EVIDENCE Therapeutic Level IV . See Instructions to Authors for a complete description of levels of evidence There have been comparatively few studies of the incidence of osteolysis and the survival of hybrid and cementless total hip replacements ( THRs ) in patients younger than 50 years of age . We prospect ively review ed 78 patients ( 109 hips ) with a hybrid THR having a mean age of 43.4 years ( 21 to 50 ) and 79 patients ( 110 hips ) with a cementless THR with a mean age of 46.8 years ( 21 to 49 ) . The patients were evaluated clinical ly using the Harris hip score , the Western Ontario and McMaster Universities ( WOMAC ) osteoarthritis score and the University of California , Los Angeles ( UCLA ) activity score .  Radiographs and CT scans were assessed for loosening and osteolysis . The mean follow-up was for 18.4 years ( 16 to 19 ) in both groups . The mean post-operative Harris hip scores ( 91 points versus 90 points ) , the mean WOMAC scores ( 11 points versus 13 points ) and UCLA activity scores ( 6.9 points versus 7.1 points ) were similar in both groups . The revision rates of the acetabular component ( 13 % versus 16 % ) and the femoral component ( 3 % versus 4 % ) , and the survival of the acetabular component ( 87 % versus 84 % ) and the femoral component ( 97 % versus 96 % ) were similar in both groups . Although the long-term fixation of the acetabular metallic shell and the cemented and cementless femoral components was outst and ing , wear and peri-acetabular osteolysis constitute the major challenges of THR in young patients The first 100 consecutive primary hip arthroplasties with the Arthopor 2 acetabular component ( Joint Medical Products , Stamford , CT ) with supplemental screw fixation performed by the senior author were prospect ively studied . The mean patient age was 57 years . Seventy-seven cemented and 23 cementless stems were placed , with 32-mm femoral heads used in most of the patients . Eighty-six hips were review ed at 7 - 8.8 years ( mean , 7.8 years ) . The mean Harris hip score at final follow-up evaluation was 94 points . No cups have been revised , although 2 cups in patients with radiation osteonecrosis were loose radiographically . One patient underwent revision of a severely worn liner . Despite a relatively high mean linear wear rate of 0.27 mm/y ( range , 0.13 - 0.57 mm/y ) , no radiographic evidence of pelvic osteolysis was seen . The Arthopor 2 cup performed well with respect to pelvic osteolysis , despite the presence of substantial polyethylene debris . The relatively high polyethylene wear rate is attributed in part to the younger patient population and the use of 32-mm femoral heads paired with thin polyethylene liners The possibility of migration of cementless cups in total joints after prophylaxis of heterotopic ossification with irradiation or nonsteroidal antiinflammatory drugs  is a concern . Data investigating component stability with digital methods are lacking . This prospect i ve study analyzed the migration of cementless cups  after indomethacin and irradiation prophylaxis  with the digital Einzel-Bild-Röntgen-Analyse tool . The irradiation group ( 106 hips ) and the indomethacin group ( 98 hips ) were compared with 82 hips that did not receive any prophylaxis . The same cementless acetabular implants were used in all cases , and patients were observed clinical ly and radiographically at 2 and 5 years . At the 5-year followup , the number of cups that showed migration greater than 1 mm in the irradiation group ( five ) , the indomethacin group ( three ) , and the control group ( four ) were not different . No cup was considered loose on the radiographs and no patient underwent revision surgery . The results of our study indicate irradiation or short-course use of indomethacin for prophylaxis of heterotopic ossification did not negatively affect the stability of cementless cups in primary total hip arthroplasties . Level of Evidence : Level II , prognostic study . See the Guidelines for Authors for a complete description of levels of evidence Surgeons who perform arthroplasties have posed some critical questions about hydroxyapatite . Does hydroxyapatite coating enhance bone ingrowth or ongrowth ? Will hydroxyapatite lead to increased polyethylene wear or an increased incidence of osteolysis ? Will the hydroxyapatite coating disappear , and if so , what will be left to maintain implant fixation ? A multicenter study of 316 hips ( 282 patients ) with a proximally hydroxyapatite coated stem and either a hydroxyapatite or porous coated cup were followed up 8.1 years ( range , 5.6 - 9.9 years ) . The average patient age was 50 years ( range , 16 - 81 years ) , and 61 % of the patients were male . One ( 0.3 % ) stem , three ( 2.7 % ) porous coated cups , and 25 ( 11.9 % ) hydroxyapatite coated cups were revised for aseptic loosening . Disappointing results on the acetabular side indicate that substrate design is critical . There were no cases of intramedullary femoral osteolysis , and the incidence of acetabular and proximal femoral osteolysis and polyethylene wear was no greater than that seen with other cementless or cemented components . Based on these clinical results and a critical review of the literature , it is concluded that hydroxyapatite coated hip components do enhance ingrowth or ongrowth with no increased incidence of osteolysis for as many as 10 years . Concern about the disappearance of the hydroxyapatite coating with time seems moot in light of the above clinical findings Purpose Very few studies have compared alumina-on-alumina ceramic and alumina-on-highly cross-linked polyethylene bearings in the same patient . The purpose of this prospect i ve r and omised study was to compare the clinical and radiographic results and the prevalence of osteolysis in cementless total hip arthroplasty using an alumina-on-alumina and alumina-on-highly cross-linked polyethylene bearings in young active patients . Methods We prospect ively compared the results of 100 patients ( 200 hips ) who had undergone a cementless total hip arthroplasty with an alumina-on-alumina ceramic bearing in one hip and an alumina-on-highly cross-linked polyethylene in the other . There were 66 men and 34 women with a mean age of 45.3 years ( range , 21–49 years ) at the time of surgery . The mean follow-up was 12.4 years ( range , 11–13 years ) . The patients were assessed clinical ly and radiographically at three months , one year , and annually thereafter . Results Harris hip , Western Ontario and McMaster Universities Osteoarthritis Index , and University of California , Los Angeles activity scores did not show statistically significant differences between the two groups of bearings preoperatively or at the time of final follow-up . Radiographic findings of the component were not significantly different between the two groups . The mean polyethylene linear penetration was 0.031 ± 0.004 mm per year . No hips in either group displayed osteolysis . The Kaplan-Meier survivorship with revision as the end point at 12.4 years was 100 % ( 95 % confidence interval [ CI ] , 94–100 % ) for the femoral component in both groups and 99 % ( 95 % CI , 93–100 % ) for the acetabular component . Conclusion The clinical and radiographic results of using an alumina-on-alumina ceramic and alumina-on-highly cross-linked polyethylene bearings were similar One hundred nineteen consecutive primary hybrid total hip arthroplasties with a precoated femoral component were performed by one surgeon in 100 patients and followed up prospect ively . Ninety-eight hips in 82 patients ( mean age , 67 years ) were evaluated clinical ly and radiographically at a mean of 6.5 years ( range , 5 - 9 years ) . The hips were evaluated clinical ly using the Harris hip score , and radiographs were evaluated for femoral cement grade , loosening , and osteolysis . Ninety-five hips remained in place at the most recent followup . Two femoral components were revised for definite loosening , and one well fixed femoral component was removed because of late hematogenous infection . Excluding the three hips that were revised , the clinical result was excellent or good in 79 hips ( 83 % ) , fair in 12 hips ( 13 % ) , and poor in four hips ( 4 % ) . All other femoral components were well fixed . There were defects of the cement mantles ( C1 and C2 ) in 90 hips . No femoral component had a stem and cement radiolucent line . Focal femoral osteolysis was seen in only two hips . One acetabular component was removed at 5 years because of late hematogenous infection . One acetabular component had asymptomatic migration . The remaining 96 acetabular components were well fixed . Focal acetabular osteolysis was present in four hips . The mean linear polyethylene wear rate was 0.06 ( + /- 0.05 ) mm per year . In contrast to other reports of early failure and osteolysis , the use of a precoated femoral component in this study did not adversely affect the fixation of hybrid total hip arthroplasty , with definite failure of only 2 % ( two of 98 ) of the femoral components Background : We previously reported our two and five‐year results of arthroplasty with the Porous Coated Anatomic total hip prosthesis . We now report on the performance of this prosthesis at ten to fourteen years . Methods : The results of 311 total hip replacements in which a Porous Coated Anatomic prosthesis was inserted without cement in 279 patients were analyzed prospect ively . The average age of the patients at the time of the replacement was sixty-one years ( range , twenty to eighty‐one years ) . Sixty‐four patients ( seventy-six hips ) died postoperatively . Forty‐five patients ( forty‐seven hips ) were lost to follow‐up , and four were excluded because of their medical condition . One hundred and sixty‐eight patients ( 187 hips ) were followed for ten to fourteen years ( average , twelve years ) . Seventeen of those patients ( seventeen hips ) had a revision . Results : The overall survival rate ( with any revision as the end point ) was 90.0 % ± 5.4 % at fourteen years , with an average Harris hip score of 85 ± 14 points . The prevalence of thigh pain was 36 % ( fifty-six of 157 ) in the late period ( more than ten years postoperatively ) . Radiographs showed stable fixation , with bone ingrowth , of 83 % ( 130 ) of the 156 acetabular components and 88 % ( 137 ) of the 156 femoral components at the latest follow‐up evaluation . Men had a significantly higher rate of femoral osteolysis than did women ( p < 0.001 ) . The rates of acetabular and femoral osteolysis associated with 32‐mm femoral heads ( 49 % [ twenty-three ] of forty-seven and 70 % [ thirty-three ] of forty-seven , respectively ) were significantly higher ( p < 0.01 ) than those associated with 26‐mm heads ( 26 % [ twenty-eight ] of 109 and 30 % [ thirty-three ] of 109 , respectively ) . Despite this , revision ( removal or exchange of components ) was not directly related to head size ; instead , it was related to polyethylene thickness . Conclusions : There have been persistent problems with the Porous Coated Anatomic hip system , including thigh pain and an increasing prevalence of osteolysis with time . Revision because of aseptic loosening was related more to the thickness of the polyethylene liner than to the size of the femoral head . Femoral heads with a 32-mm diameter did not increase the risk for revision provided that an adequate thickness of polyethylene had been used Introduction We conducted a prospect i ve study to evaluate the long-term results after Corin C-Fit uncemented total hip arthroplasty in young patients with hydroxyapatite or porous coated components . Material s and methods We prospect ively followed 36 patients ( 38 hips ) who had Corin C-Fit uncemented total hip arthroplasties by eight experienced consultant surgeons at two centres . The acetabular and femoral components were hydroxyapatite or porous coated . Results The overall 10-year survival rate for the Corin C-Fit arthroplasty was 43 % . The 10-year survivorship for the femoral implant was 56 % and for the acetabular component 59 % . Conclusion The evidence presented in this study suggests that the Corin C-Fit uncemented total hip arthroplasty has one of the highest mid- and long-term failure rates for both femoral and acetabular components in the literature . We believe this implant should not be used and patients who have had this form of total hip arthroplasty should be kept under regular review Total hip arthroplasty has been associated with excellent implant survival rates , but debate remains concerning the best fixation method for the components . A r and omized controlled trial , which included 250 patients ( mean age , sixty-four years ) with osteoarthritis who were managed with total hip arthroplasty between October 1987 and January 1992 , was conducted to compare the results of fixation with and without cement .  Patients were followed for a mean of twenty years ( range , seventeen to twenty-one years ) .  Kaplan-Meier survivorship analysis at twenty years revealed significantly lower survival rates for cemented implants as compared with cementless implants . The cementless tapered stem had an extremely good survival rate of 99 % . Radiographs showed evidence of mild stress-shielding around 95 % of the cemented stems and 88 % of the cementless stems ; stress-shielding of grade 3 or greater was seen around the remaining 12 % of the cementless stems One hundred and eighty-four patients who had been managed , between 1984 and 1985 , with a total of 204 consecutive primary total hip arthroplasties with insertion of a Harris-Galante type-I acetabular component without cement were prospect ively studied . There were eighty-two men ( 45 per cent ) and 102 women ( 55 per cent ) . The mean age at the time of the operation was fifty-two years ( range , twenty to eighty-four years ) . One hundred and fifty-seven patients ( 173 hips ) were available for clinical review at a mean of 104 months ( range , seventy-eight to 126 months ) . At this time , the mean preoperative Harris hip score of 52 points ( range , 12 to 79 points ) had improved to a mean of 90 points ( range , 44 to 100 points ) . Two patients ( two hips ) had had an exchange of an excessively worn polyethylene liner . One patient ( one hip ) had had débridement and grafting of an area of massive retroacetabular osteolysis . Two stable acetabular components ( 1 per cent ) had been revised at the time of femoral revision . None of the cups had been revised because of aseptic loosening . Radiographic examination of 150 patients ( 165 hips ) at a mean of 104 months ( range , seventy-eight to 126 months ) revealed that 156 cups ( 95 per cent ) were stable . Eight cups ( 5 per cent ) were considered to be possibly unstable , with a radiolucent line between the prosthesis and the bone that was one millimeter wide or less in at least four of five zones ; two of the eight had a complete radiolucent line in all zones . One component , which had been implanted with a bulk allograft from a femoral head , migrated more than two millimeters in the first two years and then stabilized without complication . Osteolysis was seen in seven acetabula ( 4 per cent ) and was limited to the periphery of the cup in six . Survivorship analysis at ten years revealed that the acetabular component had a 99 per cent chance of survival ( 95 per cent confidence interval , 0.98 to 1.0 ) with revision or aseptic loosening as the end point and a 97 per cent chance of survival ( 95 per cent confidence interval , 0.95 to 1.0 ) with revision , aseptic loosening , or reoperation because of a problem related to the acetabular component as the end point
RESULTS The meta- analysis did not reveal any effect of the type of acetabular component fixation on either survivorship or revision rate .
The preference for cementless acetabular components on the basis of improved survivorship is not supported by the published evidence .
Although concerns regarding aseptic loosening of cemented acetabular components may have led North American surgeons toward the nearly exclusive use of cementless acetabular components , the available literature suggests that the fixation of cemented acetabular components is more reliable than that of cementless components beyond the first postoperative decade
BACKGROUND The use of cementless acetabular components in total hip arthroplasty has gained popularity over the past decade .
Most total hip arthroplasties being performed in North America currently use cementless acetabular components .
The objective of this systematic review and meta- analysis was to compare the survivorship and revision rate of cemented and cementless acetabular components utilized in total hip arthroplasty .