Concerns and improvements with cementless metal-backed acetabular components.

The relatively high incidence of acetabular component failure shown in long-term followup studies of cemented total hip replacement has led to the use of noncemented fixation on the acetabular side of the total hip arthroplasty. In the first generation of noncemented acetabular devices, large-size femoral heads requiring thinner polyethylene were used with many of the popular designs. These components were also modular, but the design considerations involved in minimizing polyethylene debris were not fully appreciated. The newer designs of noncemented acetabular components are addressing the need to minimize wear and the production of particulate debris at the bearing surface and metal-polyethylene interface. Newer techniques also have been developed to provide initial component stability and bone-prosthesis contact. With these improvements, the results of noncemented acetabular fixation may outperform the results with cemented fixation. This may be especially true when considering the ease of insertion and versatility of noncemented acetabular components.