Review Article| Volume 27, ISSUE 8, P1544-1553.e10, September 2012

Cemented All-Polyethylene Acetabular Implants Vs Other Forms of Acetabular Fixation

A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Published:February 15, 2012DOI:


      The cost of primary total hip replacement products approaches 65% of the total reimbursement. Durability of total hip replacement resides with the acetabular component. This systematic review and meta-analysis determined if the outcomes of durability, function, and adverse events associated with cemented all-polyethylene acetabular components was similar to other acetabular designs, holding other variables constant. Randomized controlled trials only were evaluated. Two independent reviewers collected the data from 6 randomized controlled trials. Appropriate statistical analysis was performed. There was no statistical difference in regard to the outcomes at various time points (≤3, 4-8, and ≥10 years) in the 907 implants evaluated. There does, however, appear to be a trend toward abject failure with cemented all-polyethylene acetabular component implants consistent with findings of increased radiolucencies more than 10years out. The issue of increased radiolucencies over time and failure with these types of implants bears closer scrutiny.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Arthroplasty
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Wilson N.A.
        • Schneller E.S.
        • Montgomery K.
        • et al.
        Hip and knee implants: current trends and policy considerations.
        Health Aff. 2008; 27: 1587
        • Bijlsma J.W.J.
        • Berenbaum F.
        • Lafeber F.P.J.G.
        Osteoarthritis: and update with relevance for clinical practice.
        Lancet. 2011; 377: 2115
      1. Zimmer 2009 annual report to shareholders. Accessed on February 20, 2001 at:

        • Kelly M.P.
        • Bozic K.J.
        Cost drivers in total hip arthroplasty: effects of procedure volume and implant selling price.
        Am J Orthop. 2009; 38: E1
        • Rikkers L.
        A surgeon's look at costs in total joint arthroplasty.
        (Accessed on: 23 January 2011 at) (March 2006)
        • Bozic K.J.
        Femoral and acetabular component utilization in the United States.
        in: Thirty Ninth Open Meeting of The Hip Society; Final scientific program February 192011
        • Maloney W.J.
        The arthritic, osteoporotic stiff hip. Surgical tips for total hip replacement.
        AAOS Proc. 2009; : 54
        • Dorr L.
        Point-counterpoint. Optimal fixation of acetabularcomponents: fixation of the acetabular component: the case for cementless bone ingrowth modular sockets.
        J Arthroplasty. 1996; 11: 3
        • Malchau H.
        • Herberts P.
        • Eisler T.
        • et al.
        The Swedish total hipreplacement register.
        J Bone Joint Surg [Br]. 2002; 84: 2
        • Corton K.
        • Au K.
        • Bourne R.B.
        Acetabular options: notes from the other side.
        Orthopedics. 2009; 32: 664
        • Bozic K.J.
        • Kurtz S.M.
        • Lau E.
        • et al.
        The epidemiology of revision total hip arthroplasty in the United States.
        J Bone Joint Surg [AM]. 2009; 91: 128
        • Yahiro M.A.
        • Gantenberg J.B.
        • Nelson R.
        • et al.
        Comparison of the results of cemented, porous-ingrowth, and threaded acetabular cup fixation.
        J Arthroplasty. 1995; 10: 339
        • Integrated Healthcare Association
        Orthopedics data compendium: use, cost, and market structure for total joint replacement. 2006 (Accessed on June 12, 2011 at) (August)
      2. Higgins JPT, Green D, editors. Cochrane handbook of systematic reviews of interventions version 5.1.0 [updated March 2010]. The Cochrane collaboration; 2011. Available from

        • Angadi D.
        • Brown S.
        • Crawfurd E.
        Cemented all-polyethylene cups versus uncemented porous coated cups—10 year results of prospective randomized study.
        J Bone Joint Surg [BR]. 2011; 93-B: 128
        • Bjørgul K.
        • Novicoff W.M.
        • Andersen S.T.
        • et al.
        Åhlund. 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.
        J Orthop Trauma. 2010; 11: 37
        • Digas G.
        • Kärrholm J.
        • Thanner J.
        Different loss of BMS using uncemented press-fit and whole polyethylene cups fixed with cement.
        Acta Orthop. 2006; 77: 218
        • Findlay I.A.
        • Miles K.
        • East D.J.
        • et al.
        A randomized controlled trial comparing methods of acetabular fixation in primary total hip replacements in elderly patients.
        in: European Federation of National Associations of Orthopedics and Traumatology (EFORT) - presentation2008
        • McCombe P.
        • Williams S.A.
        A comparison of polyethylene wear rates between cemented and cementless cups.
        J Bone Joint Surg [Br]. 2004; 86-B: 344
        • Önsten I.
        • Carlsson Å.S.
        • Besjaov J.
        Wear in uncemented porous and cemented polyethylene sockets.
        J Bone Joint Surg [Br]. 1998; 80-B: 345
        • Angadi D.S.
        • Crawfurd E.
        A prospective randomized study of all-polyethylene versus porous-coated acetabular components.
        in: 2010 AAOS annual meeting podium presentations 2010;Presentation made on March 102010 (podium no: 113)
        • Bucher T.
        • Cottam H.L.
        • Butler-Manuel A.
        • et al.
        A randomised prospective trial comparing methods of acetabular implant fixation in primary total hip replacements; early results.
        Eur Orthop Res Soc. 2006; 16: P28
        • Digas G.
        • Thanner J.
        • Anderberg C.
        • et al.
        Bioactive cement or ceramic/porous coating vs. conventional cement to obtain early stability of the acetabular cup. Randomized study of 96 hips followed with radiostereometry.
        J Orthop Res. 2004; 22: 1035
        • Önsten I.
        • Carlsson Å.S.
        Cemented versus uncemented socket in hip arthroplasty.
        Acta Orthop Scand. 1994; 65: 517
        • Önsten I.
        • Carlsson Å.S.
        • Ohlin A.
        • et al.
        Migration of acetabular components, inserted with and without cement,in one-stage bilateral hip arthroplasty.
        J Bone Joint Surg [Am]. 1994; 76-A: 185
        • Garellick G.
        • Malchau H.
        • Herberts P.
        The charnley versus the spectron hip prosthesis: clinical evaluation of a randomized, prospective study of 2 different hip implants.
        J Arthroplasty. 1999; 14: 407
        • Wykman A.
        • Olsson E.
        • Axdorph G.
        • et al.
        Total hip arthroplasty.
        J Arthroplasty. 1991; 6: 19
        • Bourne R.B.
        • Rorabeck C.H.
        • Laupacis A.
        • et al.
        A randomized clinical trial comparing cemented to cementless total hip replacement in 250 osteoarthritic patients: the impact of health related quality of life and cost effectiveness.
        Iowa Orthop J. 1994; 14: 108
        • Laupacis A.
        • Bourne R.
        • Rorabeck C.
        • et al.
        Comparison of total hip arthroplasty performed with and without cement: a randomized trial.
        J Bone Joint Surg [Am]. 2002; 84: 1823
        • Fitzpatrick R.
        • Shortall E.
        • Sculpher M.
        • et al.
        Primary total hip replacement surgery: a systematic review of outcomes and modeling of cost-effectiveness associated with different prostheses.
        Health Technol Assess. 1998; 2
        • Smith S.W.
        • Estok D.M. I.I.
        • Harris W.H.
        Total hip arthroplasty with use of second generation cementing techniques: an eighteen year average follow up study.
        J Bone Joint Surg [AM]. 1998; 80: 1632
        • Illgen R.
        • Rubash H.E.
        The optimal fixation of the cementless acetabular component in primary total hip arthroplasty.
        J Am Acad Orthop Surg. 2002; 10: 43
      3. National Joint Registry for England and Wales.
        in: 7th annual report for England and Wales2010 (Accessed on August 2, 2011 at)
        • Swedish Hip Arthroplasty Register
        Annual report 2008.
        (Accessed on August 2, 2011 at)
      4. Harlt A, Schillinger M, Wanivenhaus A. Cemented versus cementless total hip arthroplasty for osteoarthritis and other non-traumatic diseases. Cochrane Database of Systematic Reviews 2004 2009; Issue 3: Art. No.: CD004850. DOI: 10.1002/14651858.CD004850.

        • Cavallo A.
        • Cerbo M.
        • Fella D.
        • et al.
        HTA Report—prosthesesfor primary total hip replacement in Italy, Rome. 2008
        • Krismer M.
        • Stockl B.
        • Fischer M.
        • et al.
        Early migration predicts late aseptic failure of hip sockets.
        J Bone Joint Surg [Br]. 1996; 78: 422
        • Önsten I.
        • Carlsson Å.S.
        Cemented versus uncemented socket in hip arthroplasty. A radiostereomertic study of 60 randomized hips followed for 2 years.
        Acta Orthop Scand. 1994; 65: 517
        • Önsten I.
        • Carlsson Å.S.
        • Ohlin A.
        • et al.
        Migration of acetabular components, inserted with and without cement, in one-stage bilateral hip arthroplasty.
        J Bone Joint Surg [AM]. 1994; 76: 185