title: A comparison of polyethylene wear rates between cemented and cementless cups. A prospective, randomised trial. 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. Prevalence of heterotopic ossification in cemented versus noncemented total hip joint replacement in patients with osteoarthrosis: a randomized clinical trial. Total hip arthroplasty. A comparison between cemented and press-fit noncemented fixation. Early radiographic results comparing cemented and cementless total hip arthroplasty. The results of the titanium-coated RM acetabular component at 20 years: a long-term follow-up of an uncemented primary total hip replacement. Results of Charnley total hip arthroplasty at a minimum of thirty years. A concise follow-up of a previous report. More failures of uncemented acetabular screw-rings than of cemented polyethylene cups in total hip arthroplasties Osteolysis in cemented versus cementless acetabular components. Indications, methods, and results of cemented, hybrid, and cement-free implantation of THR. 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. The Nicolas Andry Award: Comparative Results of Cemented and Cementless Total Hip Arthroplasty A double-blind study of 250 cases comparing cemented with cementless total hip arthroplasty. Cost-effectiveness and its impact on health-related quality of life. Cemented versus uncemented socket in hip arthroplasty. A radiostereometric study of 60 randomized hips followed for 2 years. Comparison of Total Hip Arthroplasty Performed with and without Cement: A Randomized Trial Total hip replacement with cemented, uncemented, and hybrid prostheses. A comparison of clinical and radiographic results at two to four years. Matched-pair analysis of cemented and cementless acetabular reconstruction in primary total hip arthroplasty. Migration of acetabular components, inserted with and without cement, in one-stage bilateral hip arthroplasty. A controlled, randomized study using roentgenstereophotogrammetric analysis.
abstract: We selected r and omly a consecutive series of 162 patients requiring hip replacement to receive either a cementless , hemispherical , modular , titanium acetabular cup or a cemented , all-polyethylene cup . These replacements were performed by two surgeons in four general hospitals . The same surgical technique was used and a 26 mm metal-head femoral component was used in every case . After exclusions , 115 hips were studied for differences in rates of wear and osteolysis . The mean clinical follow-up was eight years and the mean radiological follow-up , 6.5 years . The cementless cups  wore at a mean rate of 0.15 mm per year and the cemented cups at 0.07 mm per year . This difference was significant ( p < 0.0001 ) . Our findings in this mid-term study suggest that cementless cups  wear more than cemented cups 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 OBJECTIVE To determine the prevalence of heterotopic bone formation in cemented versus noncemented total hip joint replacement . DESIGN A prospect i ve r and omized controlled trial . Follow-up ranged from 2 to 6 years ( mean 4 years ) . SETTING A university hospital . PATIENTS Two hundred and twenty-six patients who had primary or secondary osteoarthrosis of the hip were stratified according to type of fixation , surgeon and age . Patients were r and omized within strata : 112 received noncemented total hip prostheses and 114 received cemented prostheses . The 2 groups were similar with respect to age and sex . INTERVENTION Primary total hip arthroplasty . A cemented ( methylmethacrylate ) or noncemented prosthesis was inserted by a lateral surgical approach . MAIN OUTCOME MEASURE The Brooker classification was used to grade heterotopic bone formation from postoperative radiographs . RESULTS Overall , 148 ( 66 % ) hips had no heterotopic ossification , 56 ( 25 % ) were Brooker class I , 14 ( 6 % ) were class II , 8 ( 3 % ) were class III and none were class IV . In the noncemented group of patients , 76 ( 68 % ) hips had no heterotopic ossification , 25 ( 22 % ) were Brooker class I , 7 ( 6 % ) were class II , 4 ( 4 % ) were class III and none were class IV . In the cemented group of patients , 72 ( 63 % ) hips had no heterotopic ossification , 31 ( 27 % ) hips were Brooker class I , 7 ( 6 % ) were class II , 4 ( 4 % ) were class III and none were class IV . CONCLUSION There was no significant difference in the prevalence of heterotopic ossification between cemented and noncemented total hip replacements in patients with osteoarthrosis This study compares cemented ( Charnley ) with noncemented ( Honart Patel-Garches ) total hip arthroplasty . 150 patients with osteoarthritis , rheumatoid arthritis , and miscellaneous conditions were r and omized into either group with 75 in each . Patients were evaluated over 5 postoperative years with examinations at 6 months , at 1 year , and then annually . Each examination involved clinical assessment , objective gait analysis , and radiographic examination . The Charnley group improved faster than the HP-Garches group during the first 2 years . At the last evaluation the results were excellent or good in 79 % in the Charnley group and 70 % in the HP-Garches group . In the HP-Garches group midthigh pain occurred in 64 % . Five patients with Charnley prostheses ( 6.7 % ) and 14 patients with HP-Garches prostheses ( 18.7 % had revision surgery to correct mechanical loosening . St and ard radiography revealed radiolucent zones in both groups , but this could not be related to the clinical outcome despite radiolucency being present in all noncemented replacements on the femoral side . Objective gait analysis confirmed inferior clinical results at 6 months in the HP-Garches group . There was no significant difference between the groups at the most recent evaluation . Our findings are not consistent with earlier optimistic expectations on press-fit noncemented total hip arthroplasties 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 In a prospect i ve study , 93 unselected consecutive uncemented hip arthroplasties were performed in 80 patients using the  titanium-coated RM acetabular component and the CLS femoral component .  The mean age of the patients at operation was 52 years ( 28 to 81 ) . None were lost to follow-up . In the 23 patients who had died ( 26 hips ) only one acetabular component had been revised . In the 57 living patients ( 67 hips ) , 13 such revisions had been performed . Of the 14 revisions , seven were for osteolysis , five for loosening and two for infection . Survival analysis of this implant showed a total probability of survival of 83 % ( 95 % confidence interval 73 to 90 ) , with all revisions as the endpoint , and a probability of 94 % ( 95 % confidence interval 87 to 98 ) with revision for aseptic loosening as the endpoint , indicating reliable long-term fixation of the titanium-coated RM acetabular component 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 Abstract The results of 498 total hip arthroplasties were prospect ively studied . In 329 patients a cemented acetabular polyethylene cup was inserted . In 169 patients a threaded socket without cement was introduced . Follow-up ranged from 6 to 8 years and follow-up rate was over 90 % . Of the 169 threaded sockets 8 required revision ( 4.7 % ) , and 3 acetabular components were seen to be loose on X-ray . Of the cemented cups , only 2 ( 0.6 % ) required revision and none were considered loose on X-ray . Résumé Présentation d’une étude prospect i ve de 498 arthroplasties totale de la hanche . Dans 329 cas , une cupule en polyéthylène cimentée a été utilesée . Dans 169 cas , un cotyle sans ciment vissé a été utilisé . 90 % des patients ont été suivis 6 à 8 ans . Parmi les 169 cupules vissées , 11 sont descellées et 8 ont dûêtre révisées ( 4,7 % ) . Il n’y a que 2 descellements des cupules cimentées qui ont dûêtre révisés ( 0,6 % ) 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 THR has become one of the most widely performed operations in orthopaedic surgery . In Germany , more than 180,000 THRs are currently done annually with increasing tendency . We use four different types of endoprostheses : ( 1 ) cemented , ( 2 ) cement-less , ( 3 ) hybrid ( cement-free implanted socket and cemented stem ) , and ( 4 ) hemi-endoprosthesis ( cemented stem without socket ) . A total number of 600 patients were included in a prospect i ve follow-up study during 5 to 20 years , with a mean follow-up period of 10 years . The relevant question of whether to use a cemented , hybrid , or cement-free version of THR is , in our opinion , no longer a concern . All the methods have their advantages , disadvantages , indications , and contraindications . After the " Endler-era " , significant differences are not noted between the groups of cemented , hybrid , and cement-less implants that impact on the clinical results and loosening rates 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 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 success of a total hip arthroplasty ( THA ) is dependent on many more parameters than simply the prosthesis used . This study has demonstrated that a r and omized controlled clinical trial of 250 patients comparing two types of hip prostheses ( cemented versus cementless ) with virtually complete follow-up examination is feasible . It also demonstrates that patients are willing to answer extensive quality -of-life question naires that allow complete assessment of the impact of hip arthroplasty on the patient 's overall health-related quality of life . This study has also demonstrated that THA is an extremely effective intervention when one assesses its ability to impact on patients health-related quality of life with no difference between cement versus cementless at two years ' follow-up examination 60 patients with arthrosis who received a Charnley total hip replacement were r and omly assigned to either an uncemented porous Harris-Galante type I socket or a cemented all-polyethylene Charnley socket .  Socket migration and rotation were studied by radiostereometry ( RSA ) for 2 years . After 2 years , all sockets were still in situ . There was no difference in migration or rotation between the 2 socket design s , nor was there any difference in pain or function . We conclude that the initial fixation of the Harris-Galante socket resembles that of the Charnley socket Background : This study was design ed to compare the fixation of a Mallory-Head total hip prosthesis with and without cement . Methods : Two hundred and fifty patients with osteoarthritis of the hip were r and omized to receive a Mallory-Head total hip prosthesis design ed for insertion with cement or the same prosthesis design ed for insertion without cement . Neither the patient nor the outcomes assessor was aware of the type of prosthesis . Outcomes were assessed with respect to mortality , revision arthroplasty , health-related quality of life ( evaluated with the Harris hip score , Merle d'Aubigné and Postel hip score , McMaster-Toronto Arthritis Patient Preference Disability Question naire ( MACTAR ) , Western Ontario and McMaster University Osteoarthritis Index ( WOMAC ) , and the time trade-off technique ) , and the six-minute-walk test . Patients were seen at three , six , and twelve months and yearly thereafter . Results : The prosthesis was inserted with cement in 124 patients and without cement in 126 patients . The mean age of the patients was sixty-four years , 48 % were female , and the mean duration of follow-up was 6.3 years . There were thirteen revisions in the group that had fixation with cement and six in the group that had fixation without cement ( p = 0.11 ) , and more femoral components were revised in the group that had fixation with cement ( twelve versus one ; p = 0.002 ) . All health-related quality -of-life measures improved postoperatively in both groups . Conclusions : In this r and omized trial , the group that had the cemented Mallory-Head hip prostheses required more revisions of the femoral component than did the group with the cementless Mallory-Head prostheses , which was perhaps related to the titanium-alloy femoral stem . Our findings are specific to the implants evaluated in this study 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 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 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
target: 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 .
background: 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 .