Choosing the socket in total hip arthroplasty.

Significant improvements have been made in the long-term results of cemented femoral components, but there has been little improvement in the results of cemented acetabular components. Polyethylene wear debris has been proposed as the most important factor causing loosening of cemented acetabular components. Polyethylene thickness and femoral-head size affect the rate of acetabular wear and loosening. The early results of total hip arthroplasty with noncemented acetabular components are promising, and many feel that they represent the state of the art. The hemispheric components with a porous coating have proven superior to most of the screw ring designs. There are potential disadvantages with the use of screws to augment fixation of the hemispheric components, and recently it has become popular to under-ream the acetabulum and press-fit the oversized acetabular component without the use of screws.