Osteolysis in cemented versus cementless acetabular components. The John Charnley Award. Practice surveillance: a practical method to assess outcome and to perform clinical research. A constrained liner cemented into a secure cementless acetabular shell. Matched-pair analysis of cemented and cementless acetabular reconstruction in primary 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. Migration of acetabular components, inserted with and without cement, in one-stage bilateral hip arthroplasty. A controlled, randomized study using roentgenstereophotogrammetric analysis. Comparison of total hip replacement with and without cement in patients younger than 50 years of age: the results at 18 years. Hybrid Total Hip Arthroplasty with a Precoated Offset Stem: Four to Nine-Year Results* The porous-coated anatomic total hip prosthesis, inserted without cement. A prospective study with a minimum of ten years of follow-up. The Nicolas Andry Award: Comparative Results of Cemented and Cementless Total Hip Arthroplasty Arthopor 2 acetabular component with screw fixation in primary hip arthroplasty: a 7- to 9-year follow-up study. Hydroxyapatite in Total Hip Arthroplasty: Clinical Results and Critical Issues 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. Results of Porous-Coated Anatomic Total Hip Arthroplasty without Cement at Fifteen Years: A Concise Follow-up of a Previous Report* Cementless Acetabular Replacement in the Young: A 5- to 10-Year Prospective Study Precoated femoral component in total hip arthroplasty. Results of 5- to 9-year followup. Primary Total Hip Arthroplasty with a Second-Generation Cementless Total Hip Prosthesis in Patients Younger Than Fifty Years of Age Influence of cement viscosity and cement mantle thickness on migration of the Exeter total hip prosthesis.
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 The senior author systematic ally began collecting preoperative and postoperative data on all the total hip arthroplasties he performed starting in July 1970 . The data collected represent a 26-year experience using practice surveillance ( preoperative and regular interval postoperative collection and analysis of outcomes ) as a method to document the outcome of the total hip arthroplasty procedure and as a method to evaluate the need for changes in the procedure . As the senior author made few selected changes in the operative procedure during the followup period , the primary author has been able to evaluate the change in outcome based on these changes . The six studies reported in the current study show the durability of the long-term results of cemented total hip arthroplasty , the improvement in radiographic reproducibility obtained on the femoral side of the construct with improved cementing techniques , the deleterious effects of using cable to reattach the greater trochanter , the deleterious effects of changing femoral component design that included a change in surface finish , the improvement in acetabular fixation using cementless fixation , and the optimization of bearing surface wear using smaller diameter femoral heads . All of these findings have been incorporated into the primary surgeon 's practice based on this practice surveillance . As shown , practice surveillance also has provided a tool for performing clinical research . Although practice surveillance of controlled cohorts never will supplant prospect i ve r and omized clinical trials in evidence based medicine , it should help each surgeon with his or her own practice and can be used as an important research tool to study the optimization of outcomes of a surgical procedure 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 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 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 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 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 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 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 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 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 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 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 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 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 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 : 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 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
A best evidence analysis for complications , wear , osteolysis , migration and clinical scores showed no superiority for either cemented or cementless socket in the RCTs .
A best evidence analysis for non RCT studies revealed better osteolysis , migration properties and aseptic loosening survival for cementless sockets ; however , wear and overall survival favoured the cemented sockets .
Purpose Total hip arthroplasty has been a very succesful orthopaedic procedure .
The optimal fixation method of the acetabular component however , has not yet been defined .
Methods We performed a systematic review using the Medline and Embase data bases to find evidence for the superiority of cemented or cementless acetabular components  on short- and long-term clinical and radiological parameters .