Matched-pair analysis of cemented and cementless acetabular reconstruction in primary total hip arthroplasty. Primary Total Hip Arthroplasty with a Porous-Coated Acetabular Component. Seven-to-Ten-Year Results* A constrained liner cemented into a secure cementless acetabular shell. The porous-coated anatomic total hip prosthesis, inserted without cement. A prospective study with a minimum of ten years of follow-up. 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. Results of Porous-Coated Anatomic Total Hip Arthroplasty without Cement at Fifteen Years: A Concise Follow-up of a Previous Report* Second-Generation Cementless Total Hip Arthroplasty: Eight to Eleven-Year Results Hybrid Total Hip Arthroplasty with a Precoated Offset Stem: Four to Nine-Year Results* Randomized comparison of reduction and fixation, bipolar hemiarthroplasty, and total hip arthroplasty. Treatment of displaced intracapsular hip fractures in healthy older patients. Arthopor 2 acetabular component with screw fixation in primary hip arthroplasty: a 7- to 9-year follow-up study. Primary Total Hip Arthroplasty with a Second-Generation Cementless Total Hip Prosthesis in Patients Younger Than Fifty Years of Age Cementless dual-mobility cup in total hip arthroplasty revision 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 Migration of acetabular components, inserted with and without cement, in one-stage bilateral hip arthroplasty. A controlled, randomized study using roentgenstereophotogrammetric analysis. What Works Best, a Cemented or Cementless Primary Total Hip Arthroplasty?: Minimum 17-year Followup of a Randomized Controlled Trial Total hip arthroplasty. A comparison between cemented and press-fit noncemented fixation. Total hip arthroplasty and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck. A randomized, controlled trial.
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 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 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 One hundred consecutive primary total hip arthroplasties performed with use of a porous-coated anatomic total hip prosthesis , fixed without cement , in ninety-one patients were followed prospect ively for a minimum of ten years . At the time of the most recent follow-up , twenty patients ( twenty-three hips ) had died and seventy-one patients ( seventy-seven hips ) were living . The average age of the living patients was sixty-six years ( range , thirty-two to ninety-two years ) , and their average Harris hip score was 84 points ( range , 33 to 100 points ) . Twelve percent ( nine ) of the seventy-seven hips were found to be associated with pain in the thigh when the patients were specifically question ed by the examiner . Eleven hips were revised during the follow-up period . Only the acetabular component was revised in six hips , only the femoral component was revised in one hip , and both the femoral and the acetabular components were revised in four hips . Of the ten acetabular revisions , one was performed because of acute dissociation of the component and eight , because of a combination of polyethylene wear , osteolysis , and loosening ; the tenth acetabular revision consisted of exchange of the liner and curettage and bone-grafting of the osteolytic area . Of the five femoral revisions , two were performed because of loosening and three , because of extensive osteolysis of the proximal aspect of the femur . Including the revised components , twelve acetabular components and five femoral components had radiographic evidence of aseptic loosening . Acetabular osteolysis occurred in seventeen hips . Femoral osteolysis occurred in thirty-nine hips : in the proximal aspect of thirty-one hips , in the distal aspect of four , and in both the proximal and the distal aspect of four . The durability of the femoral fixation documented in this study is especially encouraging in view of the fact that this was our initial experience with devices fixed without cement and that a so-called first-generation femoral component was used . However , the study also demonstrated that not all acetabular components fixed without cement function well over the long term and that specific design considerations ( adequate initial fixation , congruency between the liner and the shell , an optimum shell-liner capturing mechanism , and a smaller femoral head ) are warranted 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 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 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 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 BACKGROUND Orthopaedic surgeons vary in their management of displaced intracapsular fractures of the hip in healthy older patients . The aim of this investigation was to determine the functional , clinical , and re source consequences of three different types of surgical treatment . METHODS The study was a multicenter r and omized controlled trial . Reduction and fixation was compared with bipolar hemiarthroplasty with cement and total hip replacement with cement .  Participating surgeons elected to r and omize their patients to be treated with either one of the three types of procedures or with either fixation or bipolar hemiarthroplasty .  Functional outcomes were measured with a hip-rating question naire and the EuroQol health status measure . Clinical outcomes included mortality and complications . The direct health service costs were compared . Participants were followed up for two years . RESULTS Two hundred and seven patients were r and omized to be treated with one of the three operations , and ninety-one were r and omized to be treated with either fixation or bipolar hemiarthroplasty .  There were no differences in the mortality rates among the treatment groups . The rate of secondary surgery was highest in the fixation group ( 39 % compared with 5 % in the group treated with bipolar hemiarthroplasty and 9 % in the group treated with total hip replacement ) . The fixation group had the worst hip-rating- question naire and EuroQol scores at four and twelve months . The total hip replacement group had significantly better functional outcome scores at twenty-four months than the other two groups . Although fixation was initially the least costly procedure , this short-term advantage was eroded by significantly higher costs for subsequent hip-related hospital admissions . CONCLUSIONS Arthroplasty is more clinical ly effective and cost-effective than reduction and fixation in healthy older patients with a displaced intracapsular fracture of the hip . The long-term results of total hip replacement may be better than those of bipolar hemiarthroplasty 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 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 Purpose Dislocation is a frequent complication in total hip arthroplasty ( THA ) revision . Cup fixation is the second concern . In order to know outcomes at two years , we prospect ively followed a continuous series of 78 patients to demonstrate that  cementless dual-mobility cup ( DMC ) used in revision THA  is safe as regards dislocation risk and bone fixation . Method We enrolled 78 consecutive patients ( 79 cases ) in a prospect i ve study . Mean interval between index surgery and revision was 12.9 years . Mean age at revision was 75.5 years . Two types of cementless DMC were used : a st and ard DMC in 68 cases with low- grade bone defect ( Paprosky grade 1 and 2 ) , and a specific design reconstruction DMC in 11 cases with severe bone loss ( Paprosky grade 3 ) . Results At two years of follow-up , 68 patients were review ed ; four were lost to follow-up . , and six patients were deceased . We identified three types of situations at risk : st and ard risk ( 33 cases ) , Paprosky grade 1 or 2 ; medium risk ( 37 cases ) , revision for recurrent instability ( 21 ) , periprosthetic fractures ( 14 ) or severe loosening Paprosky grade 3 without femorotomy ( 2 ) ; high risk ( nine cases ) , revision for severe loosening with a femorotomy . One ( 1.3 % ) patient dislocated her hip at one month without recurrence . Revision rate for dislocation was 0 % ; two ( 2.7 % ) early mechanical failures occurred . Conclusion Considering outcomes of this series , cementless DMC can be suggested in THA revision surgery 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 Twenty-one patients who had primary osteoarthrosis were managed with a bilateral total hip arthroplasty with insertion of a Charnley femoral component . In each patient , one hip was r and omly allocated to have a Harris-Galante acetabular component inserted without cement , and the contralateral hip was treated with an all-polyethylene Charnley acetabular component fixed with cement . The clinical result was satisfactory in all patients . All forty-two hips were followed , with respect to migration of the acetabular component , with use of roentgenstereophotogrammetric analysis for a median of twenty-seven months ( range , twenty-three to forty-nine months ) . Each patient served as his or her own control . Maximum migration in any direction was 1.7 and 2.1 millimeters , and maximum rotation was 2.2 and 2.0 degrees for the Harris-Galante and Charnley acetabular components , respectively . There was no significant difference in migration between the two design s of acetabular components ( p = 0.98 , p = 0.75 , and p = 0.06 for the transverse , longitudinal , and sagittal axes , respectively ) . However , the Harris-Galante acetabular components  rotated significantly more than the Charnley acetabular components around two of the three axes ( p = 0.008 , p = 0.08 , and p = 0.03 for the transverse , longitudinal , and sagittal axes , respectively ) . The Charnley hip implant has been used clinical ly for a long time , with successful results . Comparison of new design s of implants with the Charnley prosthesis is therefore important . Roentgenstereophotogrammetric analysis provides a potential for detection of problems with fixation at an early stage rather than after long-term follow-up . No major difference in terms of skeletal fixation was found between the two design s of components after short to medium-term follow-up Background  Total hip arthroplasty ( THA )  has been associated with high survival rates , but debate remains concerning the best fixation mode of THA . Questions / purpose sWe conducted a r and omized controlled trial ( RCT ) with 250 patients with a mean age of 64 years between October 1987 and January 1992 to compare the results of cementless and cemented fixation . Patients and Methods Patients were evaluated for revision of either of the components . One hundred twenty-seven patients had died ( 51 % ) and 12 ( 4.8 % ) were lost to followup . The minimum 17-year followup data ( mean , 20 years ; range , 17–21 years ) for 52 patients of the cementless group and 41 patients of the cemented group were available for evaluation . Results Kaplan-Meier survivorship analysis at 20 years revealed lower survival rates of cemented compared with cementless THA . The cementless tapered stem was associated with a survivorship of 99 % . Age younger than 65 years and male gender were predictors of revision surgery . Conclusions The efficacy of future RCTs can be enhanced by r and omizing patients in specific patient cohorts stratified to age and gender in multicenter RCTs . Including only younger patients might improve the efficacy of a future RCT with smaller sample sizes being required . A minimum 10-year followup should be anticipated , but this can be expected to be longer if the difference in level of quality between the compared implants is smaller . Level of Evidence Level I , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence This study compares cemented ( Charnley ) with noncemented ( Honart Patel-Garches ) total hip arthroplasty . 150 patients with osteoarthritis , rheumatoid arthritis , and miscellaneous conditions were r and omized into either group with 75 in each . Patients were evaluated over 5 postoperative years with examinations at 6 months , at 1 year , and then annually . Each examination involved clinical assessment , objective gait analysis , and radiographic examination . The Charnley group improved faster than the HP-Garches group during the first 2 years . At the last evaluation the results were excellent or good in 79 % in the Charnley group and 70 % in the HP-Garches group . In the HP-Garches group midthigh pain occurred in 64 % . Five patients with Charnley prostheses ( 6.7 % ) and 14 patients with HP-Garches prostheses ( 18.7 % had revision surgery to correct mechanical loosening . St and ard radiography revealed radiolucent zones in both groups , but this could not be related to the clinical outcome despite radiolucency being present in all noncemented replacements on the femoral side . Objective gait analysis confirmed inferior clinical results at 6 months in the HP-Garches group . There was no significant difference between the groups at the most recent evaluation . Our findings are not consistent with earlier optimistic expectations on press-fit noncemented total hip arthroplasties BACKGROUND Hemiarthroplasty and total hip arthroplasty are commonly used to treat displaced intracapsular fractures of the femoral neck , but each has disadvantages and the optimal treatment of these fractures remains controversial . METHODS In the present prospect ively r and omized study , eighty-one patients who had been mobile and lived independently before they had sustained a displaced fracture of the femoral neck were r and omized to receive either a total hip arthroplasty or a hemiarthroplasty .  The mean age of the patients was seventy-five years . Outcome was assessed with use of the Oxford hip score , and final radiographs were assessed . RESULTS After a mean duration of follow-up of three years , the mean walking distance was 1.17 mi ( 1.9 km ) for the hemiarthroplasty group and 2.23 mi ( 3.6 km ) for the total hip arthroplasty group , and the mean Oxford hip score was 22.3 for the hemiarthroplasty group and 18.8 for the total hip arthroplasty group . Patients in the total hip arthroplasty group walked farther ( p=0.039 ) and had a lower ( better ) Oxford hip score ( p=0.033 ) than those in the hemiarthroplasty group . Twenty of thirty-two living patients in the hemiarthroplasty group had radiographic evidence of acetabular erosion at the time of the final follow-up . None of the hips in the hemiarthroplasty group dislocated , whereas three hips in the total hip arthroplasty group dislocated . In the hemiarthroplasty group , two hips were revised to total hip arthroplasty and three additional hips had acetabular erosion severe enough to indicate revision . In the total hip arthroplasty group , one hip was revised because of subsidence of the femoral component . CONCLUSIONS Total hip arthroplasty conferred superior short-term clinical results and fewer complications when compared with hemiarthroplasty in this prospect ively r and omized study of mobile , independent patients who had sustained a displaced fracture of the femoral neck
A best evidence analysis for complications , wear , osteolysis , migration and clinical scores showed no superiority for either cemented or cementless socket in the RCTs .
A best evidence analysis for non RCT studies revealed better osteolysis , migration properties and aseptic loosening survival for cementless sockets ; however , wear and overall survival favoured the cemented sockets .
Purpose Total hip arthroplasty has been a very succesful orthopaedic procedure .
The optimal fixation method of the acetabular component however , has not yet been defined .
Methods We performed a systematic review using the Medline and Embase data bases to find evidence for the superiority of cemented or cementless acetabular components  on short- and long-term clinical and radiological parameters .