Patients experienced significant post-THR improvements in Harris Hip scores , but this did not differ between impact types .
Recipients of cross-linked vs. conventional polyethylene cup liners experienced reduced femoral head penetration and revision .
There was no impact of femoral stem fixation and cup shell design on implant survival rates .
Evidence on mortality and complications ( aseptic loosening , femoral fracture ) was inconclusive .
BACKGROUND Evolvements in the design , fixation methods , size , and bearing surface of implants for  total hip replacement ( THR ) have led to a variety of options for healthcare professionals to consider .
The need to determine the most optimal combinations of THR implant is warranted .
This systematic review evaluated the clinical effectiveness of different types of THR used for the treatment of end stage arthritis of the hip .
The Charnley stem: clinical, radiological and survival data after 11-14 years.
BACKGROUND The Charnley stem provides good outcome for 10 years , but several studies find deteriorating results thereafter . However , study population s , techniques and data analysis vary widely . We have studied 240 Charnley stems in a homogeneous group of patients providing clinical , radiological and survival data after 11 - 14 years . HYPOTHESIS The clinical and radiological outcome of the Charnley stem is not as good than previously thought . PATIENTS AND METHODS Five surgeons implanted 240 femoral stems in a community hospital in Norway using antibiotic impregnated cement and third generation cementing techniques . The Charnley stems were implanted with a Charnley cup in 120 cases and an uncemented hemispherical cup ( Duraloc ) in 120 cases . The mean age of the patients was 65.5 years and the mean Body Mass Index ( BMI ) was 26.8 . All patients received low molecular weight heparin and antibiotic prophylaxis . Patients were assessed after 10 years by means of Harris Hip Score ( HHS ) and radiographic evaluation . Implant survival studies were performed after 11 - 14 years . RESULTS One hundred and fifty-eight patients were available for clinical and radiographic evaluation after 10 years . HHS improved from 48.4 ( 95 % CI : 46.6 - 50,2 ) preoperatively to 87.9 ( 95%CI : 86.6 - 89.3 ) after 6 months and 87.6 ( 95 % CI : 85.3 - 89.8 ) at 10 years . Thirty-one stems had been revised , the reasons for revision were loosening ( 21 ) , infection ( five ) , instability ( four ) and late perisprosthetic fracture ( one ) . Forty-one stems had one or more signs of loosening . Stem survival was 83.6 % using any revisions as end point , and mean estimated stem survival was 12.7 years ( 12.2 - 13.3 years ) . DISCUSSION Other studies report survival at mid-term from 83 - 96 % . Our results are in the low-end . Even though our rate of infection was high ( 2 % ) , the main cause of the poor results is aseptic loosening . We do not know the reason for this high-rate of loosening . As we believe that our technique is adequate and patient population average , we suspect that this rate of loosening is a characteristic of the implant . Results from this prospect i ve cohort study add to the evidence that the Charnley stem should not be used hip arthroplasty unless patient life expectancy is less than 10 years
Patients experienced significant post-THR improvements in Harris Hip scores , but this did not differ between impact types .
Recipients of cross-linked vs. conventional polyethylene cup liners experienced reduced femoral head penetration and revision .
There was no impact of femoral stem fixation and cup shell design on implant survival rates .
Evidence on mortality and complications ( aseptic loosening , femoral fracture ) was inconclusive .
BACKGROUND Evolvements in the design , fixation methods , size , and bearing surface of implants for  total hip replacement ( THR ) have led to a variety of options for healthcare professionals to consider .
The need to determine the most optimal combinations of THR implant is warranted .
This systematic review evaluated the clinical effectiveness of different types of THR used for the treatment of end stage arthritis of the hip .