Good diagnostic performance of early migration as a predictor of late aseptic loosening of acetabular cups: results from ten years of follow-up with Roentgen stereophotogrammetric analysis (RSA). Early migration predicts late aseptic failure of hip sockets. Primary Total Hip Arthroplasty with a Porous-Coated Acetabular Component. Seven-to-Ten-Year Results* Cementless coated and noncoated Mathys acetabular cups: radiographic and histologic evaluation. A Dual-mobility Cup Reduces Risk of Dislocation in Isolated Acetabular Revisions Ten-year results with the Morscher press-fit cup: an uncemented, non-modular, porous-coated cup inserted without screws Cementless Acetabular Replacement in the Young: A 5- to 10-Year Prospective Study The beneficial effect of hydroxyapatite lasts No Migration of Acetabular Cups after Prophylaxis for Heterotopic Ossification Clinical and radiographic outcomes of total hip arthroplasty with insertion of an anatomically designed femoral component without cement for the treatment of primary osteoarthritis. A study with a minimum of six years of follow-up. Early migration and late aseptic failure of proximal femoral prostheses. The dual-mobility POLARCUP: first results from a multicenter study. High long-term loosening rate of conical screw cups Influence of cement viscosity and cement mantle thickness on migration of the Exeter total hip prosthesis. Five-year clinical, radiological and postmortem results of the Cambridge Cup in patients with displaced fractures of the neck of the femur. Custom stems for femoral deformity in patients less than 40 years of age 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. Hydroxyapatite in Total Hip Arthroplasty: Clinical Results and Critical Issues Highly Crosslinked Polyethylene Does Not Reduce Aseptic Loosening in Cemented THA 10-year Findings of a Randomized Study Total hip replacement with cemented, uncemented, and hybrid prostheses. A comparison of clinical and radiographic results at two to four years. Results of Charnley total hip arthroplasty at a minimum of thirty years. A concise follow-up of a previous report. Can Dual Mobility Cups prevent Dislocation in All Situations After Revision Total Hip Arthroplasty? Migration of the uncemented Harris-Galante acetabular cup: results of the einbildroentgenanalyse (EBRA) method. Precoated femoral component in total hip arthroplasty. Results of 5- to 9-year followup. No differences in outcomes between cemented and uncemented acetabular components after 12–14 years: results from a randomized controlled trial comparing Duraloc with Charnley cups Denosumab reduces early migration in total knee replacement
BACKGROUND Excessive early migration of femoral stems following total hip arthroplasty and tibial components following total knee arthroplasty is associated with their long-term survival and allows reliable early evaluation of implant performance . However , a similar relationship involving acetabular components following hip arthroplasty has not been evaluated . This prospect i ve , long-term study with clinical and Roentgen stereophotogrammetric analysis ( RSA ) follow-up establishes the existence of this relationship and its associated diagnostic performance . METHODS Thirty-nine consecutive patients ( forty-one hips ) who underwent total hip arthroplasty with a cemented Exeter stem and a cemented Exeter all-polyethylene cup had prospect i ve clinical and RSA follow-up . Patients were evaluated postoperatively at six weeks , at three , six , and twelve months , and annually thereafter . Conventional anteroposterior and lateral radiographs were made at six weeks and at two , five , and ten years postoperatively as well as when indicated . The mean duration of follow-up ( and st and ard deviation ) was 9.4 ± 3.2 years . No patients were lost to follow-up ; fifteen patients died during the follow-up period . RESULTS Eleven acetabular components were observed to be loose on conventional radiographs after a mean of seventy-six months ( range , twelve to 140 months ) . During the first two postoperative years , the failed acetabular components showed markedly greater and more rapid cranial translation and sagittal rotation . Both cranial translation ( hazard ratio = 19.9 [ 95 % confidence interval , 4.94 to 80.0 ] , p < 0.001 ) and sagittal rotation ( hazard ratio = 11.1 [ 95 % confidence interval , 2.83 to 43.9 ] , p = 0.001 ) were strong risk factors for late aseptic loosening . Eight of the eleven failed components showed a distinctive pattern of excessive cranial translation combined with excessive sagittal rotation . The associated diagnostic performance of two-year cranial translation and /or sagittal rotation for predicting late aseptic loosening of the acetabular component was good ( area under the receiver operating characteristic curve , 0.88 [ 95 % confidence interval , 0.74 to 1.00 ; p < 0.001 ] and 0.84 [ 95 % confidence interval , 0.68 to 1.00 ; p = 0.001 ] , respectively ) . CONCLUSIONS Early migration , as measured by RSA at two years postoperatively , has good diagnostic capabilities for the detection of acetabular components at risk for future aseptic loosening , and this method appears to be an appropriate means of assessing the performance of new implants or implant-related changes We report a prospect i ve , stratified study of 60 PCA-cups and 60 RM-polyethylene cups which have been followed for a median time of 90 months , with annual radiography .  The radiological migration of cups was measured by the computer-assisted EBRA method . A number of threshold migration rates from 1 mm in the first year to 1 mm in five years have been assessed and related to clinical ly determined revision rates . A total of 28 cups showed a total migration of 1 mm or more within the first two years ; 13 of these cups have required revision and been exchanged . The survival curves of cups which had previously shown early migration were considerably different from those without early migration . For cups with a migration of less than 1 mm within the first two years the mean survival at 96 months was 0.96 + /- 0.02 ; for migrating cups , it was 0.63 + /- 0.11 ( log-rank test , p=0.0001 ; chi-square value=39.4 ) . Early migration is a good predictor for late loosening of hip sockets 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 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 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 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 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 and purpose In contrast to early migration , the long-term migration of hydroxyapatite- ( HA- ) coated tibial components in TKA has been scantily reported . This r and omized controlled trial investigated the long-term migration measured by radiostereometric analysis ( RSA ) of HA-coated , uncoated , and cemented tibial components in TKA . Patients and methods 68 knees were r and omized to HA-coated ( n = 24 ) , uncoated ( n = 20 ) , and cemented ( n = 24 ) components .  All knees were prospect ively followed for 11–16 years , or until death or revision .  RSA  was used to evaluate migration at yearly intervals . Clinical and radiographic evaluation was according to the Knee Society system . A generalized linear mixed model ( GLMM , adjusted for age , sex , diagnosis , revisions , and BMI ) was used to take into account the repeated-measurement design . Results The present study involved 742 RSA analyses . The mean migration at 10 years was 1.66 mm for HA , 2.25 mm for uncoated and 0.79 mm for the cemented group ( p < 0.001 ) . The reduction of migration by HA as compared to uncoated components was most pronounced for subsidence and external rotation . 3 tibial components were revised for aseptic loosening ( 2 uncoated and 1 cemented ) , 3 for septic loosening ( 2 uncoated and 1 cemented ) , and 1 for instability ( HA-coated ) . 2 of these cases were revised for secondary loosening after a period of stability : 1 case of osteolysis and 1 case of late infection . There were no statistically significant differences between the fixation groups regarding clinical or radiographic scores .  Interpretation HA reduces migration of uncemented tibial components . This beneficial effect lasts for more than 10 years . Cemented components showed the lowest migration . Longitudinal follow-up of TKA with RSA allows early detection of secondary loosening The possibility of migration of cementless cups in total joints after prophylaxis of heterotopic ossification with irradiation or nonsteroidal antiinflammatory drugs  is a concern . Data investigating component stability with digital methods are lacking . This prospect i ve study analyzed the migration of cementless cups  after indomethacin and irradiation prophylaxis  with the digital Einzel-Bild-Röntgen-Analyse tool . The irradiation group ( 106 hips ) and the indomethacin group ( 98 hips ) were compared with 82 hips that did not receive any prophylaxis . The same cementless acetabular implants were used in all cases , and patients were observed clinical ly and radiographically at 2 and 5 years . At the 5-year followup , the number of cups that showed migration greater than 1 mm in the irradiation group ( five ) , the indomethacin group ( three ) , and the control group ( four ) were not different . No cup was considered loose on the radiographs and no patient underwent revision surgery . The results of our study indicate irradiation or short-course use of indomethacin for prophylaxis of heterotopic ossification did not negatively affect the stability of cementless cups in primary total hip arthroplasties . Level of Evidence : Level II , prognostic study . See the Guidelines for Authors for a complete description of levels of evidence We evaluated the clinical and radiographic outcomes of 100 consecutive primary total hip arthroplasties in which a proximally coated anatomically design ed femoral component was fixed without cement for the treatment of primary osteoarthritis . The minimum duration of follow-up was six years ( average , 7.1 years ) . The eighty-eight patients who had the arthroplasties were followed prospect ively with a st and ard clinical evaluation that involved use of the Harris hip score and a radiographic evaluation based on the criteria of the Hip Society . Bone ingrowth was evaluated with the method of Engh et al. The average age of the patients at the time of the operation was 62.6 years ( range , thirty-nine to eighty-four years ) . Fifty-one patients were men and thirty-seven were women . The average preoperative Harris hip score was 48 points , with an average pain score of 15 points and an average function score of 26 points . Nonmechanical complications that necessitated a revision operation included one deep hematogenous infection , one late periprosthetic fracture , and a 0.5-inch ( 1.27-centimeter ) limb-length discrepancy . At the time of the most recent follow-up , the average Harris hip score was 96 points , with an average pain score of 42 points and an average function score of 45 points . The prevalence of pain in the anterior part of the thigh was 5 percent ( five hips ) . One patient had a revision of the femoral component because of aseptic loosening , and one had a revision of the acetabular component because of recurrent dislocations . Radiographic assessment revealed consistent evidence of proximal bone ingrowth . No complete radiolucent line was identified , except around the stem that had loosened . Twenty-seven femoral components were associated with slight pedestal formation . No osteolytic lesion of the femur was identified . Nonprogressive pelvic osteolysis was identified in four hips , but none of the lesions were more than two millimeters in diameter . None of the acetabular components migrated , and no radiolucent line of more than two millimeters in thickness was seen around any acetabular cup . The data from this study , in which the minimum duration of follow-up was six years , indicate that the anatomically design ed prosthesis can provide good results , with low prevalences of pain in the thigh and loosening of the component , in younger , active patients The  vertical migration of four configurations of a proximal femoral prosthesis , followed for up to nine years , was measured on st and ard radiographs . The same implant was used without cement ( group 1 ) and with cement ( group 2 ) . The migration of both groups was linear from six months onwards . The mean migration rate and the incidence of late aseptic loosening were both greater in group 1 . Survival analysis of the two groups , however , showed no statistically significant difference . In both groups , hips later destined for revision migrated more rapidly from the initial postoperative period onwards , than did the remainder . A threshold migration of 1.2 mm/year during the first two years after implantation detected hips likely to fail with a specificity of 86 % and a sensitivity of 78 % . This ' migration test ' was applied to the results in two further groups of patients in which a modified femoral prosthesis had been implanted without hydroxyapatite coating ( group 3 ) and with hydroxyapatite coating  ( group 4 ) . The test distinguished between the four groups and suggested that at least two fixation procedures should be ab and oned . We conclude that vertical migration measured on st and ard radiographs in the first two years after implantation can be used to predict late aseptic loosening . New prosthetic configurations should be evaluated by migration measurements before their general release . Our observations support the view that one cause of late aseptic loosening is imperfect initial fixation Dislocation is a leading cause of revision after  total hip arthroplasty ( THA ) . To address this risk , dual-mobility technology was developed , which features a mobile polyethylene liner locked onto a femoral head and articulating in a metallic acetabular shell . This study reports clinical outcome data after implantation of the third-generation POLARCUP Dual-Mobility System ( Smith & Nephew Orthopaedics AG , Rotkreuz , Switzerl and ) .  Primary THA procedures were performed in 150 patients . At 7.1 years , cumulative cup survival according to Kaplan-Meier was 97.4 % . The mean Postel-Merle d'Aubigne score improved from 8.9 to 17.1 during the investigation . Two cups were revised at 5.4 and 6.4 years because of aseptic loosening . No dislocations were observed during follow-up . The current results confirm excellent early to midterm clinical outcomes for the POLARCUP Dual-Mobility System Background  Acetabular screw cups  seem to give high primary stability . We analyzed the migration and loosening behavior of a first-generation screw cup in a longterm follow-up . Patients and methods We examined 92 uncemented titanium alloy conical screw cups prospect ively .  Implant migration was assessed with a digital high-precision method ( EBRA ) with an accuracy of 1.0 mm . Results After mean 11 ( 0.5–18 ) years , 87 patients were available for examination and 5 patients had died . 32 implants had been revised and 7 cases showed radiographic evidence of loosening . The 10-year survival rate was 71 % . Migration of more than 1 mm occurred in 53 hips . Implant survival was strongly associated with an annual migration of greater than 0.2 mm . Interpretation The long-term behavior of this cup is not satisfactory . In spite of extraordinarily high primary implant stability , secondary osseointegration of this cup often fails . The annual migration rate represents a valid parameter for prediction of implant survival The effect of bone cement viscosity and cement mantle thickness on the migration of the Exeter  total hip prosthesis  was studied in a prospect i ve , r and omized , double-blind clinical Roentgen Stereophotogrammetric Analysis study . Forty-one cemented total hip arthroplasty in 39 patients were included and r and omized into a low/medium Simplex P cement group and a high-viscosity Simplex AF cement group . At time of stem introduction , 5 minutes after mixing , the Simplex AF was more viscous than Simplex P. No statistical difference existed between the 2 cement groups , for neither translation nor rotation migration data . Subsidence of the stem at 2-year follow-up was 1.1 + /- 0.56 mm for Simplex AF cement and 1.5 + /- 1.00 mm for Simplex P cement . The mean rotation of the acetabular components about the sagittal axis was 1.7 degrees + /- 3.8 degrees in the Simplex AF group and 0.7 degrees + /- 2.1 degrees for the Simplex P group . No effect of cement mantle thickness on migration of neither the acetabular cups nor the femoral stems was found . Although there were no differences in migration data for the cups and the stems , 2 acetabular cups in the Simplex AF group ( almost 10 % ) were revised because of mechanical loosening . Because of these findings , we suggest caution before using this new high-viscosity bone cement for fixation of acetabular components The Cambridge Cup has been design ed to replace the horseshoe-shaped articular cartilage of the acetabulum and the underlying subchondral bone . It is intended to provide physiological loading with minimal resection of healthy bone . The cup has been used in 50 women with displaced , subcapital fractures of the neck of the femur . In 24 cases , the cup was coated with hydroxyapatite . In 26 , the coating was removed before implantation in order to simulate the effect of long-term resorption . The mean Barthel index and the Charnley-modified Merle d'Aubigné scores recovered to their levels before fracture . We review ed 30 women at two years , 21 were asymptomatic and nine reported minimal pain .  The mean scores deteriorated slightly after five years reflecting the comorbidity of advancing age . Patients with the hydroxyapatite-coated components remained asymptomatic , with no wear or loosening . The uncoated components migrated after four years and three required revision . This trial shows good early results using a novel , hydroxyapatite-coated , physiological acetabular component Background and purpose Femoral deformity associated with osteoarthritis is a challenge for both the surgeon and the implant . Many of the patients with these deformities are young . St and ard implants can be difficult to fit into these femurs . We prospect ively evaluated the outcome of custom uncemented femoral stems in young patients . Methods 61 consecutive patients ( 72 hips ) underwent surgery for osteoarthritis because of femoral deformity at a mean age of 35 ( 22–40 ) years . The patients received a CT3D-A custom-made femoral stem and an uncemented cup . The mean follow-up time was 14 ( 10–16 ) years . 2 patients died at 7 and 8 years after surgery , otherwise , none of the patients were lost to follow-up . Results At follow-up , the femoral prosthesis had not been revised in 59 patients ( 70 hips ) . 3 patients ( 3 hips ) had required revision surgery due to loosening of the acetabular component ; 2 hips were awaiting revision surgery for loosening of the acetabular cup . There were no cases of dislocation or infection . At review , all stems were considered stable according to the radiographic criteria . No migration or subsidence was observed on plain radiographs . Interpretation Our results are comparable to published results of custom stems regarding survival and outcome . Considering the young age and the deformities in this series of uncemented custom femoral stems , and the fact that there was follow-up of up to 16 years , the survival is remarkable . This technique appears to be a reasonable alternative in younger patients with femoral deformities 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 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 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 One hundred and thirty-one patients who had 144 cemented or uncemented hip prostheses  were followed prospect ively for two to four years . A cemented or a hybrid prosthesis ( consisting of a cemented femoral component and an uncemented acetabular component ) was used in men older than seventy years , in women older than sixty years , and in younger patients in whom adequate initial fixation could not be obtained without cement . Uncemented , porous-surfaced implants were used in all other patients . The over-all clinical results were similar for the three groups . For the fifty-two hips that had a cemented prosthesis , the mean total Harris hip rating was 91 points and the score for pain , 42 points ; for the twenty-seven hips that had a hybrid prosthesis , 90 and 43 points ; and for the sixty-five hips that had an implant allowing ingrowth of bone in both the acetabulum and the femur , 95 and 43 points . Two prosthetic stems that were design ed to allow ingrowth of bone had aseptic loosening ; one was revised . Pain in the thigh , usually slight and not disabling , occurred at one year in 24 per cent of the patients in whom a femoral component allowing ingrowth had been used ; the prevalence of pain then declined . The incidences of migration of the components and of radiolucent lines were greater in the acetabula that had a cemented component than in those that had a cup allowing ingrowth of bone 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 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 Seventy primary total hip arthroplasties using the Harris-Galante acetabular cup ( Zimmer , Warsaw , IN ) were prospect ively examined . Over the entire period of 65.4+/-7.8 months ,  radiologic migration analysis  was performed using the  Einbildroentgenanalyse  ( EBRA ) method at an accuracy of 1 mm . Although there was clinical ly no suspicion of prosthetic loosening in any case , in 8 implants ( 11.4 % ) migration of more than 1 mm was observed . Cranial migration occurred in 3 cases ( 1.1 , 1.3 and 1.6 mm ) , medial migration in 3 cases ( 1.1 , 1.1 , and 2.9 mm ) , and lateral migration in 2 cases ( 1.1 and 1.1 mm ) . In the other 62 cases , however , no migration was traceable . Compared with measurements of other implant systems by means of the EBRA method published recently by other groups , the migration rate of the Harris-Galante cup was without exception lower and provided excellent midterm implant stability One hundred nineteen consecutive primary hybrid total hip arthroplasties with a precoated femoral component were performed by one surgeon in 100 patients and followed up prospect ively . Ninety-eight hips in 82 patients ( mean age , 67 years ) were evaluated clinical ly and radiographically at a mean of 6.5 years ( range , 5 - 9 years ) . The hips were evaluated clinical ly using the Harris hip score , and radiographs were evaluated for femoral cement grade , loosening , and osteolysis . Ninety-five hips remained in place at the most recent followup . Two femoral components were revised for definite loosening , and one well fixed femoral component was removed because of late hematogenous infection . Excluding the three hips that were revised , the clinical result was excellent or good in 79 hips ( 83 % ) , fair in 12 hips ( 13 % ) , and poor in four hips ( 4 % ) . All other femoral components were well fixed . There were defects of the cement mantles ( C1 and C2 ) in 90 hips . No femoral component had a stem and cement radiolucent line . Focal femoral osteolysis was seen in only two hips . One acetabular component was removed at 5 years because of late hematogenous infection . One acetabular component had asymptomatic migration . The remaining 96 acetabular components were well fixed . Focal acetabular osteolysis was present in four hips . The mean linear polyethylene wear rate was 0.06 ( + /- 0.05 ) mm per year . In contrast to other reports of early failure and osteolysis , the use of a precoated femoral component in this study did not adversely affect the fixation of hybrid total hip arthroplasty , with definite failure of only 2 % ( two of 98 ) of the femoral components Background Even though there are multiple studies documenting the outcome of the Charnley low-friction arthroplasty as well as abundant studies on uncemented arthroplasties , there is a dearth of comparative studies of the uncemented acetabular component and a cemented component . In this study we aim ed to document the long-term clinical and radiographic outcome as well as component survival in a r and omized controlled trial . Material s and methods Two hundred fifteen patients ( 240 hips ) were r and omly allocated to receive a cemented Charnley cup or uncemented Duraloc 1200 cup . All patients received cemented Charnley stems and were evaluated clinical ly and radiographically after 6 months , and 2 , 5 , and 10 years . Results Harris Hip Scores improved from 48.3 [ 95 % confidence interval ( CI ) 45.0–51.6 ] to 90.2 [ 95 % CI 87.9–92.6 ] in the Charnley group and from 49.3 [ 95 % CI 86.9–91.3 ] in the Duraloc group at 6 months . After 10 years , the Charnley group ’s Harris Hip Score was 89.8 [ 95 % confidence interval ( CI ) 87.0–92.6 ] , and the Duraloc group ’s score was 87.3 ( 95 % CI 84.1–90.6 ) . In the radiographic analysis after 10 years , there was no statistical difference in the prevalence of radiographic signs of loosening . Nine cups were revised in the Charnley group , and five cups were removed in the Duraloc group . The difference was not statistically significant . There was no statistical difference between the cups when aseptic loosening was the end-point , nor in survival analyses . Conclusions There is no statistically significant difference in clinical or radiological outcome between the Charnley cup and the Duraloc after 10 years , and no difference in implant survival after 12–14 years . The uncemented Duraloc cup is as good as the cemented Charnley cup after 10 years Background and purpose — Aseptic loosening is a main cause of late revision in total knee replacement ( TKR ) . Migration of implants as measured by radiostereometric analysis ( RSA ) can predict future loosening . This migration is associated with bone resorption . Denosumab is a human monoclonal antibody that binds to receptors on osteoclast precursors and osteoclasts . This prevents osteoclast formation , result ing in less bone resorption in cortical and trabecular bone . We investigated whether denosumab can reduce migration of TKR , as measured with RSA . Patients and methods — In this 2-center , r and omized , double-blind  placebo-controlled  trial , 50 patients with osteoarthritis of the knee were treated with an injection of either denosumab ( 60 mg ) or placebo 1 day after knee replacement surgery and again after 6 months . RSA was performed postoperatively and after 6 , 12 , and 24 months . The primary effect variable was RSA maximal total point motion ( MTPM ) after 12 months . We also measured other RSA variables and the knee osteoarthritis outcome score ( KOOS ) . Results — The primary effect variable , MTPM after 12 months , showed that migration in the denosumab group was statistically significantly less than in the controls . Denosumab  MTPM 12 months was reduced by one-third ( denosumab : median 0.24 mm , 10 % and 90 % percentiles : 0.15 and 0.41 ; placebo : median 0.36 mm , 10 % and 90 % percentiles : 0.20 and 0.62 ) . The secondary MTPM variables ( 6 and 24 months ) also showed a statistically significant reduction in migration . There was no significant difference in MTPM for the period 12–24 months . KOOS sub-variables were similiar between denosumab and placebo after 12 and 24 months . Interpretation — Denosumab reduces early migration in total knee replacement , as in previous trials using bisphosphonates . As migration is related to the risk of late loosening , denosumab may be beneficial for long-term results
INTERPRETATION There was a clinical ly relevant association between early migration of acetabular cups  and late revision due to loosening .
BACKGROUND AND PURPOSE The association between excessive early migration of acetabular cups  and late aseptic revision has been scantily reported .
We therefore performed 2 parallel systematic review s and meta-analyses to determine the association between early migration of acetabular cups  and late aseptic revision .