Press-fit, hydroxyapatite-coated acetabular cup designs may offer a lower incidence of loosening and migration than older designs. Our study evaluated the initial clinical and radiographic success of a cementless acetabular shell in a large cohort of primary total hip arthroplasty (THA) patients. We queried our institution’s prospectively collected registry for a series of 771 primary THAs (695 patients) implanted with this cup by 4 high-volume arthroplasty surgeons. Of the 613 hips with minimum 2-year followup, average HHS (Harris Hip Score) was 93.6, WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) was 87.6, and VAS (Visual Analog Scale) pain score was 1.2. While there was a 2% reoperation rate (12 hips), none of the cups were revised for aseptic loosening. No radiolucencies were found and there was no evidence of acetabular loosening. At early followup, this newer cementless acetabular cup implant design exhibits high survivorship and clinical success. 1. Introduction When cementless acetabular cups were initially introduced in primary total hip arthroplasty (THA), studies showed mixed clinical outcomes, with problems such as failure of the locking system of the liner and the thinness of the polyethylene. Newer generations of press-fit acetabular components have been used with increasing frequency and high success rates [1–3]. Its advantages over previous generation cementless cup designs include the elimination of screw/cup fretting and corrosion, decreased neurovascular injury risk, and elimination of screw holes. Mid- and long-term studies have shown it to have favorably low rates of osteolysis and loosening [4–15]. However, in an effort to improve on the performance of press-fit cups, attention has turned towards the use of hydroxyapatite coating (HA) in conjunction with the porous coating found on most commercially available acetabular cups. Previous designs of HA-coated acetabular shells have shown mixed results at mid-term followup [3]. Studies have demonstrated that HA-coated, porous acetabular components significantly enhanced bone ongrowth in the presence of wear particles, preventing migration and reducing osteolysis [16]. HA-coated porous and sintered beaded components provided a more effective seal against the ingress of wear debris when compared with cemented cups [1]. However, other studies have shown that HA-coating has no effect on the revision rate of cementless cups [17]. Some of the unfavorable results could be attributed to manufacturing techniques such as the quality of powder, roughness of implants, method
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