Ten-year results with the Morscher press-fit cup: an uncemented, non-modular, porous-coated cup inserted without screws Hydroxyapatite in Total Hip Arthroplasty: Clinical Results and Critical Issues Cross-linked Compared with Historical Polyethylene in THA: An 8-year Clinical Study Primary total hip arthroplasty with a cementless porous-coated anatomic total hip prosthesis: 10- to 12-year results of prospective and consecutive series. Primary Total Hip Arthroplasty with a Porous-Coated Acetabular Component. Seven-to-Ten-Year Results* Highly Crosslinked Polyethylene Does Not Reduce Aseptic Loosening in Cemented THA 10-year Findings of a Randomized Study Arthopor 2 acetabular component with screw fixation in primary hip arthroplasty: a 7- to 9-year follow-up study.
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 Surgeons who perform arthroplasties have posed some critical questions about hydroxyapatite . Does hydroxyapatite coating enhance bone ingrowth or ongrowth ? Will hydroxyapatite lead to increased polyethylene wear or an increased incidence of osteolysis ? Will the hydroxyapatite coating disappear , and if so , what will be left to maintain implant fixation ? A multicenter study of 316 hips ( 282 patients ) with a proximally hydroxyapatite coated stem and either a hydroxyapatite or porous coated cup were followed up 8.1 years ( range , 5.6 - 9.9 years ) . The average patient age was 50 years ( range , 16 - 81 years ) , and 61 % of the patients were male . One ( 0.3 % ) stem , three ( 2.7 % ) porous coated cups , and 25 ( 11.9 % ) hydroxyapatite coated cups were revised for aseptic loosening . Disappointing results on the acetabular side indicate that substrate design is critical . There were no cases of intramedullary femoral osteolysis , and the incidence of acetabular and proximal femoral osteolysis and polyethylene wear was no greater than that seen with other cementless or cemented components . Based on these clinical results and a critical review of the literature , it is concluded that hydroxyapatite coated hip components do enhance ingrowth or ongrowth with no increased incidence of osteolysis for as many as 10 years . Concern about the disappearance of the hydroxyapatite coating with time seems moot in light of the above clinical findings Abstract Wear particle-induced osteolysis is a major cause of aseptic loosening in THA . Increasing wear resistance of polyethylene ( PE ) occurs by increasing the cross-link density and early reports document low wear rates with such implants . To confirm longer-term reductions in wear we compared cross-linked polyethylene ( irradiation in nitrogen , annealing ) with historical polyethylene ( irradiation in air ) in a prospect i ve , r and omized clinical study involving 48 patients who underwent THAs with a minimum followup of 7 years ( mean , 8 years ; range , 7–9 years ) . The insert material was the only variable . The Harris hip score , radiographic signs of osteolysis , and polyethylene wear were recorded annually . Twenty-three historical and 17 moderately cross-linked polyethylene inserts were analyzed ( five patients died , three were lost to followup ) . At 8 years , the wear rate was lower for cross-linked polyethylene ( 0.088 ± 0.03 mm/year ) than for the historical polyethylene ( 0.142 ± 0.07 mm/year ) . This reduction ( 38 % ) did not diminish with time ( 33 % at 5 years ) . Acetabular cyst formation was less frequent ( 39 % versus 12 % ) , affected fewer DeLee and Charnley zones ( 17 % versus 4 % ) , and was less severe for the cross-linked polyethylene . The only revision was for an aseptically loose cup in the historical polyethylene group . Moderately cross-linked polyethylene maintained its wear advantage with time and produced less osteolysis , showing no signs of aging at mid-term followup . Level of Evidence : Level I , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence We performed a prospect i ve study in 108 consecutive patients ( 116 hips ) who were followed for a minimum of 10 years ( 10 - 12 years ) after primary total hip arthroplasty using an uncemented porous-coated anatomic ( PCA ) hip prosthesis . The average age of the patients at operation was 48.4 years ( range , 19 - 85 years ) , and the diagnosis was avascular necrosis of the femoral head in 46 hips , neglected femoral neck fracture in 27 , osteoarthrosis secondary to childhood pyogenic arthritis in 24 , childhood tuberculous arthritis in 5 , and miscellaneous in 14 . The average preoperative Harris Hip Score was 55 points , which improved to 87 points at 11 years . Seventy-five hips ( 65 % ) were excellent , 11 ( 9 % ) were good , and 30 ( 39 % ) were poor . The overall rate of revision was 15 % ( 17 of 116 hips ) . The rate of revision of the femoral component was 11 % ( 13 of 116 hips ) , and the rate of revision of the acetabular component was 15 % ( 17 of 116 hips ) . The prevalence of thigh pain was 28 % at 11 years . The increase in the incidence of aseptic loosening of the femoral component was found to explain the high incidence of severe thigh pain at 11 years ' follow-up . At 11 years , there was femoral osteolysis in 69 hips ( 59 % ) and acetabular osteolysis in 65 hips ( 56 % ) . At 6 years , 20 hips ( 17 % ) showed definite wear of the polyethylene liner . At 11 years , 81 hips ( 70 % ) showed definite wear of the polyethylene liner . Because the complication rate of the PCA hip prosthesis with respect to loosening , osteolysis , and excessive wear in the polyethylene liner is high , we ab and oned the use of this implant 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 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 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
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 .