Results of uncemented cups: a critical appraisal at 15 years.

One of the most important advances in total hip arthroplasty is the development of successful cementless acetabular components. Cemented acetabular components in older patients showed increasing loss of fixation after the first decade. Loosening commonly occurred during the first decade in young patients and after revision surgeries. Although some cementless designs failed, the hemispheric design with a porous exterior surface now is adopted widely. Assessment of acetabular reconstructions should be evaluated as primary operations in the older age group, primary operations in younger patients, and revisions. In all three categories, the cementless hemispheric design has proven remarkably successful. For example, a compilation of three reports on acetabular revisions using the HGP design revealed that by 12.5 years, only five of 263 shells required shell re-revision (2%). Periprosthetic osteolysis and dislocation are problems, but are being addressed by improved articulations and designs. These advances are remarkable in generating successful long-term acetabular reconstructions.