Ten-year results with the Morscher press-fit cup: an uncemented, non-modular, porous-coated cup inserted without screws Effect of augmented cup fixation on stability, wear, and osteolysis: a 5-year follow-up of total hip arthroplasty with RSA. More failures of uncemented acetabular screw-rings than of cemented polyethylene cups in total hip arthroplasties A Dual-mobility Cup Reduces Risk of Dislocation in Isolated Acetabular Revisions Highly Crosslinked Polyethylene Does Not Reduce Aseptic Loosening in Cemented THA 10-year Findings of a Randomized Study Highly Cross-Linked Polyethylene in Cemented THA: Randomized Study Of 61 Hips Cementless coated and noncoated Mathys acetabular cups: radiographic and histologic evaluation. Can Dual Mobility Cups prevent Dislocation in All Situations After Revision Total Hip Arthroplasty? Arthopor 2 acetabular component with screw fixation in primary hip arthroplasty: a 7- to 9-year follow-up study. Bioactive cement or ceramic/porous coating vs. conventional cement to obtain early stability of the acetabular cup. Randomised study of 96 hips followed with radiostereometry. Matched-pair analysis of cemented and cementless acetabular reconstruction in primary total hip arthroplasty. Cementless dual-mobility cup in total hip arthroplasty revision Comparison of dual-mobility cup and unipolar cup for prevention of dislocation after revision total hip arthroplasty Primary Total Hip Arthroplasty with a Porous-Coated Acetabular Component. Seven-to-Ten-Year Results* EBRA migration patterns of the Plasmacup with ceramic or polyethylene inserts: a randomised study. Cementless Acetabular Replacement in the Young: A 5- to 10-Year Prospective Study Segment choice and cup stability influence wear measurements using radiostereometric analysis: a radiostereometric study comparing wear measured by markers in the polyethylene with markers in the periacetabular bone.
Total  hip arthroplasty ( THA )  with well design ed cementless acetabular implants has shown excellent results . The purpose of this study was to assess our clinical and radiological outcomes using an uncemented cup . We conducted a prospect i ve cohort study including all consecutive primary THAs performed with the Morscher press-fit cup , an uncemented non-modular acetabular component , between March 1996 and December 1998 . Patients were evaluated at ten years with clinical and radiological follow-up , patient satisfaction and question naire assessment using the Harris hip score ( HHS ) , Merle d’Aubigné and Postel score , the UCLA score , the 12-item short-form health survey ( SF-12 ) and a visual analog scale .  Five hundred sixty-one THAs were performed in 518 patients . At 120 months ( ± 7.3 months ) , 303 patients with 335 THAs were still available for follow-up . None of the patients had required cup revision for aseptic loosening . At ten years , the cup survivorship was 98.8 % ( 95 % CI 97.4–99.5 ) with cup revision for any cause as an endpoint . No radiolucencies were seen around the cups , but osteolytic defects involved 21 stems ( 8.3 % ) . Mean total linear polyethylene wear was 0.9 mm . The Morscher acetabular replacement cup provides excellent results at ten years . There were no revisions for aseptic loosening of the cup , and no osteolytic defects were found around the cup . Patient satisfaction was high and the clinical results were very good To evaluate different modes of cementless fixation of hemispherical cups , we operated on 87 hips in 81 patients using 4 different means of cup fixation . The hips were r and omly assigned to fixation with press-fit technique only ( PF ) , or with augmentation with screws ( S ) , pegs ( P ) , or hydroxyapatite ( HA ) coating . The patients were evaluated with radiostereometric analysis ( RSA ) for cup migration and wear , conventional radiography for osteolysis , and Harris Hip Score for clinical outcome over 5 years . The fixation of the cups did not differ between the groups , but HA showed a tendency to decrease proximal migration . HA-coated cups displayed the best interface with hardly any signs of radiolucent lines , indicating a superior sealing effect of the HA coating . Cups with screws or pegs had more radiolucent lines and osteolytic lesions than the other groups . Radiolucent lines were correlated to higher proximal migration , young age , and female gender ( r2=.2 ) . The wear rate of the ethylene oxide-sterilized polyethylene liner was high ( 0.2 mm/y ) but did not differ between the groups . Two cups with a perioperative fracture of the acetabular rim showed large initial migration but stabilized thereafter Abstract The results of 498 total hip arthroplasties were prospect ively studied . In 329 patients a cemented acetabular polyethylene cup was inserted . In 169 patients a threaded socket without cement was introduced . Follow-up ranged from 6 to 8 years and follow-up rate was over 90 % . Of the 169 threaded sockets 8 required revision ( 4.7 % ) , and 3 acetabular components were seen to be loose on X-ray . Of the cemented cups , only 2 ( 0.6 % ) required revision and none were considered loose on X-ray . Résumé Présentation d’une étude prospect i ve de 498 arthroplasties totale de la hanche . Dans 329 cas , une cupule en polyéthylène cimentée a été utilesée . Dans 169 cas , un cotyle sans ciment vissé a été utilisé . 90 % des patients ont été suivis 6 à 8 ans . Parmi les 169 cupules vissées , 11 sont descellées et 8 ont dûêtre révisées ( 4,7 % ) . Il n’y a que 2 descellements des cupules cimentées qui ont dûêtre révisés ( 0,6 % ) Background Isolated acetabular revisions using st and ard cups are at risk of dislocation . The introduction of a nonconstrained dual-mobility cup was design ed to improve prosthetic stability without increasing loosening rates , but it is unclear whether the risk of dislocation is reduced . Questions / purpose sWe therefore determined : ( 1 ) if the rate of dislocation in isolated acetabular revisions is lower with a dual-mobility cup , ( 2 ) implant survival , ( 3 ) patient function , and ( 4 ) radiographic incidence of migration , loosening , and osteolysis . Methods We prospect ively followed 33 selected patients who underwent isolated acetabular revisions with a minimum of 2 years ’ followup ( mean , 3 years ; range , 2–5 years ) . In 24 patients a stainless steel dual-mobility cup was cemented into an antiprotrusio cage , whereas in nine we used a hyaluronan dual-mobility revision cup with a foramen hook and superior and posterior flanges screw fixations . We determined Harris hip ( HHS ) and WOMAC scores and examined radiographs for migration , loosening , and osteolysis . Results There were no dislocations . Survivorship rates of the femoral and acetabular components were 97 % at 5 years ; the rerevision rate for any reason was 3 % . At last followup , the mean HHS increased from 48 points preoperatively to 86 points . No patients had progressive osteolysis , component migration , or loosening on radiographs . Conclusion In this select group of isolated acetabular revisions , our data suggest the use of a dual-mobility cup reduced the risk of dislocation without increasing loosening from 2 to 5 years . Level of Evidence Level IV , therapeutic study . See the Guidelines for Authors for a complete description of levels of evidence Background Polyethylene ( PE ) wear particles are believed to cause aseptic loosening and thereby impair function in hip arthroplasty .  Highly crosslinked polyethylene ( XLPE ) has low short- and medium-term wear rates . However , the long-term wear characteristics are unknown and it is unclear whether reduced wear particle burden improves function and survival of cemented hip arthroplasty . Questions / purpose sWe asked whether XLPE wear rates remain low up to 10 years and whether this leads to improved implant fixation , periprosthetic bone quality , and clinical function compared to conventional PE . Methods We r and omized 60 patients ( 61 hips ) to receive either PE or XLPE cemented cups combined with a cemented stem .  At 10 years postoperatively , 51 patients ( 52 hips ) were evaluated for polyethylene wear and component migration estimation by radiostereometry , for radiolucent lines , bone densitometry , and Harris hip and pain scores . Revisions were recorded . Results XLPE cups had a lower mean three-dimensional wear rate between 2 and 10 years compared to conventional PE hips : 0.005 mm/year versus 0.056 mm/year . We found no differences in cup migration , bone mineral density , radiolucencies , functional scores , and revision rate . There was a trend toward improved stem fixation in the XLPE group . The overall stem failure rate was comparably high , without influencing wear rate in XLPE hips . Conclusions XLPE displayed a low wear rate up to 10 years when used in cemented THA , but we found no clear benefits in any other parameters . Further research is needed to determine whether cemented THA design s with XLPE are less prone to stem loosening . Level of Evidence Level I , therapeutic study . See the Instructions for Authors for a complete description of levels of evidence Highly cross-linked polyethylene ( PE ) has been introduced as an alternative bearing material in total hip arthroplasty ( THA ) because of high wear resistance in laboratory tests but the clinical experience of this material is limited . We evaluated a highly cross-linked PE ( warm irradiated adiabatic melting , absorbed dose , 95 kGy ) in a r and omized study of cemented THAs . Cups of the same design but made of conventionally gamma irradiated PE ( absorbed dose , 25–40 kGy ) constituted the control group . Sixty-one hips ( 30 women , 30 men ) with a median age of 55 years ( range , 35–70 years ) were included . All patients received a Spectron stem with 28-mm CoCr head . Radiostereometric examinations with the patient supine or st and ing were done at regular intervals . Wear was measured with the patient in the supine position from the first postoperative week , whereas examinations done with the patient st and ing were initiated 3 months after the operation . Dual xray absorptiometry and conventional radiography were used to evaluate the bone mineral density and the radiolucencies around the acetabular component .  Fifty-two patients ( 53 hips ; 25 highly cross-linked , 28 control ) have been followed up for 2 years . At the 2-year followup , the highly cross-linked cups showed 50 % reduction of proximal wear compared with the control group , when the patients were studied st and ing . When evaluated supine , the difference in proximal wear did not reach significance . The migration of the socket , the relative changes of periprosthetic bone mineral density , and the progression of radiolucencies between the immediately postoperative followup and 2-year followup did not differ . Highly cross-linked PE showed increase resistance to wear . Different mechanical properties of the two types of PE studied did not alter the performance of the cup in terms of fixation , periprosthetic bone loss , and radiographic appearance . However , the followup is short and these results are preliminary This study evaluated 185 cementless Mathys coated and uncoated acetabular cups inserted for total hip replacement since September 1984 . All of the cups were high-density polyethylene .  Sixty were uncoated ( group A ) , 96 were coated with hydroxyapatite ( group B ) , and 29 were coated with titanium ( group C ) .  Cup survival was assessed clinical ly , histologically , and radiographically , and a computer-assisted EBRA method was used to evaluate cup migration . After a mean follow-up of 8 years , five cups in group A that had previously shown migration were revised as a result of aseptic loosening , while no loosening of hip sockets occurred in groups B and C. These results suggest that Mathys cups should be used only if coated with hydroxyapatite or titanium . Furthermore , the histologic evaluation in four cups from groups B and C revealed normal bone formation without inflammation or fibrotic tissue around the cups , promising long-term survival UNLABELLED The outcome of a single design of dual mobility cup was prospect ively evaluated in a continuous series of 994 revision THAs with respect to dislocation and intra-prosthetic dislocation ( IPD ) . At a 7.3-year mean follow-up , the dislocation rate was 1.5 % and the IPD rate was 0.2 % . The 2 IPD occurred in acetabular-only revisions and were related to a poor head-to-neck ratio with early impingement and wear at the polyethylene mobile component chamfer . Dual mobility cups demonstrated a low dislocation rate in revision THA but did not compensate for potential perioperative technical errors . In addition , IPD did not appear to be a concern with respect to the benefit in term of instability prevention though caution is advised in acetabular-only revision associated with a poor head-to-neck ratio . LEVEL OF EVIDENCE Therapeutic study -Level IV 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 Ninety patients ( 96 hips ) scheduled for THA were stratified to fixation of the acetabular component in three main groups of about equal size . Fluoride cement , porous coated press-fit cup with ceramic coating or Palacos cum Gentamicin cement were used . All patients received Spectron EF stem .  The migration of the cups and the femoral head penetration into the socket were measured with radiostereometric analysis . At 2 years the choice of fixation did not influence the migration or rotation of the cup .  Patients with compromised bone quality showed increased three-dimensional ( 3D or total ) migration . Proximal and 3D penetration rates were increased in cemented compared with the uncemented cups ( p<0.001 ) , which probably not could be related to the choice of fixation . Appearance of radiolucent lines was almost equal in the two cemented groups . Uncemented cups had less radiolucent lines at 2 years . Fluoride containing cement or uncemented fixation did not improve the early postoperative stability of the socket 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 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 Background and purpose — Revision total hip arthroplasty ( THA ) is associated with higher dislocation rates than primary THA . We compared the risk of dislocation within 6 months and all-cause re-revision during the whole study period using either the dual-mobility cup or the unipolar cup . Methods — We used a prospect i ve hospital registry-based cohort including all total and cup-only revision THAs performed between 2003 and 2013 . The cups used were either dual-mobility or unipolar ; the choice was made according to the preference of the surgeon . 316 revision THAs were included . The mean age of the cohort was 69 ( 25–98 ) years and 160 THAs ( 51 % ) were performed in women . The dual-mobility group ( group 1 ) included 150 THAs ( 48 % ) and the mean length of follow-up was 31 ( 0–128 ) months . The unipolar group ( group 2 ) included 166 THAs ( 53 % ) and the mean length of follow-up was 52 ( 0–136 ) months . Results — The incidence of dislocation within 6 months was significantly lower with the dual-mobility cup than with the unipolar cup ( 2.7 % vs. 7.8 % ) . The unadjusted risk ratio ( RR ) was 0.34 ( 95 % CI : 0.11–1.02 ) and the adjusted RR was 0.28 ( 95 % CI : 0.09–0.87 ) . The number of patients needed to treat with a  dual-mobility cup in order to prevent 1 case of dislocation was 19 . The unadjusted incidence rate ratio for all-cause re-revision in the dual-mobility group compared to the unipolar group was 0.6 ( 95 % CI : 0.3–1.4 ) . Interpretation — Use of a dual-mobility rather than a unipolar cup in revision THA reduced the risk of dislocation within 6 months 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 AIM In this prospect i ve r and omised study , the influence of different bearing material s on migration and wear was measured and their effect on the function of the artificial joint and the patient outcome was investigated . Mid-term results were recorded so that recommendations can be made on the use of certain bearings , which minimise wear and thus the danger of subsequent aseptic loosening . METHOD Sixty-six patients met the inclusion criteria and were willing to take part in the study . These patients were r and omised to 2 groups . All of them had total hip arthroplasty with implantation of a cementless Bicontact stem and Plasmacup using a cementless press-fit technique . Thirty-five of these patients were given a ceramic-ceramic bearing and 31 patients a ceramic-polyethylene bearing ( gamma sterilised/nitrogen environment ) . At the most recent follow-up , they underwent detailed clinical and radiological examination and evaluation by means of the Harris Hip Score , Hannover function question naire and single-film X-ray analysis ( EBRA ) . RESULTS The overall follow-up rate was 65.2 % ( 43 of 66 ) and the mean follow-up period was 8.1 ( 7.1 - 9.2 ) years . The median Harris Hip Score at the time of follow-up was 90.1 ( 58.7 - 99.9 ) points . The average Hannover function score was 87.14 % ( 63.9 - 100 ) . In 4 of 66 cases ( 6.1 % ) there was a tendency for the Plasmacup to subsidence in the first postoperative months that was slight but detectable by EBRA ; however , this stopped subsequently . This primary subsidence was independent of the chosen bearing material . No significant difference in the clinical and radiological parameters was found between the two groups . CONCLUSION The very good results with regard to the rate of loosening confirm the press-fit cup fixation concept . The study shows a similar medium-term result for the ceramic-ceramic and ceramic-polyethylene bearing so that use of both bearings can continue to be recommended . Only long-term studies with sufficiently large numbers of patients will be able to show whether significant differences can be detected between the two slide bearings with regard to wear and migration behaviour and so that a recommendation can be given to the surgeon This article presents a prospect i ve clinical and radiologic review of 55 total hip replacements in 50 patients in which the cementless Harris-Galante porous-coated acetabular component was used . All patients were 50 years of age or younger . The cups were inserted by 15 different surgeons . The minimum followup was 5 years , with a mean of 7 years . No acetabular component has been revised for loosening , and none have migrated . Three ( 5.5 % ) cups have progressive bone-component radiolucent lines , two ( 3.6 % ) of which are complete . Six ( 10.9 % ) acetabular liners have been replaced for excessive polyethylene wear , and an additional four ( 7.3 % ) show sufficient wear to produce obvious radiographic eccentricity of the femoral head . All of the revised liners had 32-mm femoral heads and an initial polyethylene thickness of less than 6 mm . Although the results reflect excellent fixation of this component in the medium term , the incidence of exchange of the polyethylene liner for excessive wear is unacceptably high . The reduction in polyethylene thickness associated with the use of a metal-backed component and a 32-mm articulation was one of the factors contributing to the accelerated wear patterns seen in this series BACKGROUND Radiostereometry is a well documented method to measure the polyethylene wear after total hip replacements . Wear is measured according to the point motion of the head center in relation to the polyethylene as the reference segment . Increasing head sizes and new cup material s may diminish visibility of markers deteriorating the segment and leading to study drop outs . Alternatively markers in the periacetabular bone may be easier to detect rendering this segment more stable . Our aim was to compare wear measurements against the cup , the acetabuluar bone and a calculated wear estimation including cup migration . METHODS A prospect i ve r and omized controlled trial comparing reverse hybrid with cemented total hip replacement was conducted . 31 patients had tantalum markers in the polyethylene and in the periacetabular bone  making it possible to measure wear using both as reference segments . We used a uniplanar radiostereometric technique . FINDINGS Wear in the y-axis was overestimated by 53 % when markers in the periacetabular bone were used ( P<0.001 ) . Proximal wear was 0.34 mm ( 95 % CI of mean : 0.29 - 0.38 ) when using the polyethylene as the reference and 0.52 mm ( 95 % CI of mean : 0.38 - 0.65 ) using the acetabular bone . Migration of the cup seemed to influence the wear calculations , overestimating wear when markers in the periacetabular bone were used as the reference segment . INTERPRETATION Wear measured with periacatebular bone markers is influenced by cup migration , overestimating wear measurements . We therefore recommend not using the acetabular bone as the reference segment
Results Best evidence analysis showed no difference in polyethylene wear rate , the frequency of cup migration , and aseptic loosening between monoblock and modular acetabular components .
No convincing evidence was found for the cl aim that lower frequencies of acetabular osteolysis are observed with the use of monoblock cups compared with modular uncemented cups .
Conclusions The purported benefits of monoblock cups were not substantiated by this systematic review of controlled studies in that polyethylene wear rates and frequencies of cup failure and acetabular osteolysis were similar to those observed with modular implants .
Background Monoblock acetabular components used in uncemented total hip arthroplasty ( THA ) have certain mechanical characteristics that potentially reduce acetabular osteolysis and polyethylene wear .
However , the degree to which they achieve this goal is not well documented .
Questions / purpose sThe purpose of this study was to use a systematic review of controlled trials to test the hypothesis that monoblock cups have superior ( 1 ) polyethylene wear rate ; ( 2 ) frequency of cup migration ; ( 3 ) frequency of acetabular osteolysis ; and ( 4 ) frequency of aseptic loosening compared with modular components used in uncemented THA .