Matched-pair analysis of cemented and cementless acetabular reconstruction in primary total hip arthroplasty. A constrained liner cemented into a secure cementless acetabular shell. The Nicolas Andry Award: Comparative Results of Cemented and Cementless Total Hip Arthroplasty Second-Generation Cementless Total Hip Arthroplasty: Eight to Eleven-Year Results Osteolysis in cemented versus cementless acetabular components. Early radiographic results comparing cemented and cementless total hip arthroplasty. Results of Porous-Coated Anatomic Total Hip Arthroplasty without Cement at Fifteen Years: A Concise Follow-up of a Previous Report* Primary Total Hip Arthroplasty with a Second-Generation Cementless Total Hip Prosthesis in Patients Younger Than Fifty Years of Age The porous-coated anatomic total hip prosthesis, inserted without cement. A prospective study with a minimum of ten years of follow-up. 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. Excellent results with cementless total hip arthroplasty and alumina-on-alumina pairing: minimum ten-year follow-up A double-blind study of 250 cases comparing cemented with cementless total hip arthroplasty. Cost-effectiveness and its impact on health-related quality of life. 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. Primary Total Hip Arthroplasty with a Porous-Coated Acetabular Component. Seven-to-Ten-Year Results* Cementless primary total hip replacement. Four to eight year results with the Zweymüller-Alloclassic prosthesis. What Works Best, a Cemented or Cementless Primary Total Hip Arthroplasty?: Minimum 17-year Followup of 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 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 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 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 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 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 : 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 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 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 Ceramic-on-ceramic coupling is thought to be a durable alternative to metal- or alumina-on-polyethylene pairing . No evidence exists suggesting superior clinical and radiological results for hydroxyapatite-coated stems versus uncoated stems . The aim of this study is to report the performance of an alumina-on-alumina bearing  cementless total hip arthroplasty and to compare stems with a tapered design with and without hydroxyapatite coating . We prospect ively analysed the results of  cementless tapered femoral stems ( 40 hydroxyapatite-coated versus 22 uncoated stems ) , a metal-backed fibre mesh hydroxyapatite-coated socket and alumina-on-alumina pairing .  Of 75 hips studied , 62 were available for follow-up ( mean of 10.5 years after surgery ) . The average Harris hip score was 90 . Only one hydroxyapatite-coated stem was revised for aseptic loosening . One instance of non-progressive osteolysis was detected around a screw of a cup . All other components showed radiographic signs of stable ingrowth .  Hydroxyapatite coating of the stem had no significant impact on the clinical or radiological results . Total hip arthroplasty with the presented implant and pairing provides a durable st and ard for all patients requiring hip joint replacement against which all newer generations of cementless implants should be judged The success of a total hip arthroplasty ( THA ) is dependent on many more parameters than simply the prosthesis used . This study has demonstrated that a r and omized controlled clinical trial of 250 patients comparing two types of hip prostheses ( cemented versus cementless ) with virtually complete follow-up examination is feasible . It also demonstrates that patients are willing to answer extensive quality -of-life question naires that allow complete assessment of the impact of hip arthroplasty on the patient 's overall health-related quality of life . This study has also demonstrated that THA is an extremely effective intervention when one assesses its ability to impact on patients health-related quality of life with no difference between cement versus cementless at two years ' follow-up examination 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 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 One hundred and twenty-nine consecutive cementless primary total hip arthroplasties with Zweymüller-Alloclassic grit-blasted titanium components  were evaluated prospect ively at an average follow-up of 5.9 years . The clinical results were grade d as excellent or good in 116 hips ( 90 % ) , fair in 12 , and poor in one due to a fracture of the femoral shaft at operation leading to early stem loosening and delayed ring loosening . Failure was defined as definite aseptic loosening , and the final survivorship at 8 years was 99.3 % for the SL-stem , and 99.1 % for the CSF-threaded cup . These early results compare favourably with those of total hip arthroplasties using new cementing techniques 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
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 .