Matched-pair analysis of cemented and cementless acetabular reconstruction in primary total hip arthroplasty. Second-Generation Cementless Total Hip Arthroplasty: Eight to Eleven-Year Results Osteolysis in cemented versus cementless acetabular components. A constrained liner cemented into a secure cementless acetabular shell. Results of Porous-Coated Anatomic Total Hip Arthroplasty without Cement at Fifteen Years: A Concise Follow-up of a Previous Report* The Nicolas Andry Award: Comparative Results of Cemented and Cementless Total Hip Arthroplasty Early radiographic results comparing cemented and cementless total hip arthroplasty. Cemented polyethylene and cementless porous-coated acetabular components have similar outcomes at a mean of seven years after total hip replacement: a prospective randomised study. Primary Total Hip Arthroplasty with a Second-Generation Cementless Total Hip Prosthesis in Patients Younger Than Fifty Years of Age Hybrid Total Hip Arthroplasty with a Precoated Offset Stem: Four to Nine-Year Results* 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 Results of Charnley total hip arthroplasty at a minimum of thirty years. A concise follow-up of a previous report. 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. Comparison of total hip replacement with and without cement in patients younger than 50 years of age: the results at 18 years.
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 : 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 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 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 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 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 The aim of this prospect i ve r and omised study was to compare the clinical and radiological results of a cemented all-polyethylene Ultima acetabular component with those of a cementless porous-coated acetabular component ( PFC ) following  total hip replacement ( THR ) . A total of 287 patients received either a polyethylene acetabular component ( group A ) or a cobalt-chromium porous-coated component ( group B ) with an identical cemented femoral component and 28 mm cobalt-chromium head , thus making it the largest study of its type . Patients were evaluated radiologically and clinical ly using the Harris hip score ( HHS ) .  Group A comprised 183 patients ( 73 male , 110 female ) with a mean age of 71.3 years ( 55 to 89 ) . Group B comprised 104 patients ( 48 male , 56 female ) with a mean age of 69.8 years ( 56 to 89 ) . A total of 16 patients ( 13 in Group A , three in Group B ) did not have post-operative data for analysis . The mean follow-up in group A was 7.52 years ( 0.4 to 15.0 ) and in Group B 7.87 years ( 0.5 to 14.0 ) . At final follow-up the mean HHS was similar between groups A and B ( 74.5 ( 25 to 100 ) and 78.0 ( 37 to 100 ) , respectively ; p = 0.068 ) . The total number of revisions for any cause was 28 , 17 of which were in group A and 11 in group B. The ten-year survivorship was 86.8 % ( 95 % confidence interval ( CI ) 78.4 to 92.1 ) and 89.2 % ( 95 % CI 78.3 to 94.8 ) for groups A and B , respectively ( log-rank p-value = 0.938 ) . A total of 20 cemented and two cementless acetabular components had evidence of acetabular radiolucencies or acetabular component migration at last follow-up ( p = 0.001 ) . These results indicate that patients with a cemented all-polyethylene and cementless porous-coated polyethylene lined acetabular component have similar long-term clinical outcomes 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 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 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 The purpose of the current study was to up date the results of a prospect i ve , single-surgeon series of primary Charnley total hip arthroplasties performed with cement . This investigation is one of the first studies in which hips treated with total hip arthroplasty with cement  were followed for a minimum of thirty years . Twenty-seven patients ( thirty-four [ 10.3 % ] of the hips in the initial study group ) were alive at a minimum of thirty years postoperatively . These patients served as the focus of the present study .  Revision because of aseptic loosening of the acetabular component was performed in 7.3 % ( twenty-three ) of the hips from the original study group ( excluding those revised because of infection or dislocation ) and 26 % ( eight ) of the hips in the living cohort .  Revision  because of aseptic loosening of the femoral component was performed in 3.2 % ( ten ) of the hips from the original study group ( excluding those revised because of infection or dislocation ) and 10 % ( three ) of the hips in the living patients . Since the twenty-five-year review , three hips were revised ( one because of acetabular loosening , one because of femoral loosening , and one because of instability ) . This end- result study demonstrated the remarkable durability of cemented Charnley total hip replacements over a span of three decades , with 88 % of the original prostheses intact at the time of the final follow-up or at the patient 's death 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 There have been comparatively few studies of the incidence of osteolysis and the survival of hybrid and cementless total hip replacements ( THRs ) in patients younger than 50 years of age . We prospect ively review ed 78 patients ( 109 hips ) with a hybrid THR having a mean age of 43.4 years ( 21 to 50 ) and 79 patients ( 110 hips ) with a cementless THR with a mean age of 46.8 years ( 21 to 49 ) . The patients were evaluated clinical ly using the Harris hip score , the Western Ontario and McMaster Universities ( WOMAC ) osteoarthritis score and the University of California , Los Angeles ( UCLA ) activity score .  Radiographs and CT scans were assessed for loosening and osteolysis . The mean follow-up was for 18.4 years ( 16 to 19 ) in both groups . The mean post-operative Harris hip scores ( 91 points versus 90 points ) , the mean WOMAC scores ( 11 points versus 13 points ) and UCLA activity scores ( 6.9 points versus 7.1 points ) were similar in both groups . The revision rates of the acetabular component ( 13 % versus 16 % ) and the femoral component ( 3 % versus 4 % ) , and the survival of the acetabular component ( 87 % versus 84 % ) and the femoral component ( 97 % versus 96 % ) were similar in both groups . Although the long-term fixation of the acetabular metallic shell and the cemented and cementless femoral components was outst and ing , wear and peri-acetabular osteolysis constitute the major challenges of THR in young patients
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 .