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Comparative Survival of Uncemented Acetabular Components Following Primary Total Hip Arthroplasty
James L. Howard, MD, MSc, FRCSC1; Hilal Maradit Kremers, MD, MSc2; Youlonda A. Loechler2; Cathy D. Schleck, BS2; William S. Harmsen, MS2; Daniel J. Berry, MD2; Miguel E. Cabanela, MD2; Arlen D. Hanssen, MD2; Mark W. Pagnano, MD2; Robert T. Trousdale, MD2; David G. Lewallen, MD2
1 Division of Orthopaedic Surgery, London Health Sciences Centre, 339 Windermere Road, London, ON N6K 4R1, Canada
2 Departments of Health Sciences Research (H.M.K., C.D.S., and W.S.H.) and Orthopedic Surgery (H.M.K., Y.A.L., D.J.B., M.E.C., A.D.H., M.W.P., R.T.T., and D.G.L.), Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for H.M. Kremers: maradit@mayo.edu
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Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

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Investigation performed at the Mayo Clinic, Rochester, Minnesota

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Sep 07;93(17):1597-1604. doi: 10.2106/JBJS.J.00195
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Since their initial introduction in the early 1980s, uncemented acetabular components have become the preferred implant type for the majority of hip arthroplasties performed in the United States. The purpose of the present study was to compare differences in the survival of uncemented acetabular components following primary total hip arthroplasty.


The study population included 7989 patients who had undergone 9584 primary total hip arthroplasties with twenty different types of uncemented acetabular components at the Mayo Clinic from January 1984 to December 2004. The overall rate of survival as well as the rate of survival free of revision for specific reasons (aseptic loosening, wear, osteolysis) were compared among the different components using age and sex-adjusted Cox proportional hazards regression models.


The risk of acetabular cup revision was significantly higher for beaded and hydroxyapatite-coated designs as compared with titanium wire mesh designs. Cross-linked polyethylene performed better than conventional polyethylene, but this finding did not reach significance. Elevated liners were associated with a significantly higher risk of cup revision due to aseptic loosening.


There are significant differences in the long-term survival of different types of uncemented acetabular components following total hip arthroplasty. The increased risk of revisions in the second decade after the initial total hip arthroplasty is a concern and is largely due to a steady increase in revisions because of polyethylene wear, osteolysis, and component loosening more than ten years after the time of the index arthroplasty.

Level of Evidence: 

Prognostic Level III. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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