Cemented Polyethylene Cups in Patients Younger Than 40 Years

Daniël C. J. de Kam MD, Jean W. M. Gardeniers MD, PhD,Jan C. M. Hendriks PhD, René P. H. Veth MD, PhD,B. Willem Schreurs MD, PhD

Clinical Orthopaedics and Related Research. Received: 27 May 2008 / Accepted: 1 April 2009 / Published online: 16 April 2009. 467:1753–1764. DOI 10.1007/s11999-009-0837-3

Abstract - Although uncemented cup implants frequently are used in young patients, we believe long-term survival rates of cups in these patients are somewhat disappointing, and therefore we have continued to use cemented cups in primary THA, even in young patients. However, in cases of acetabular bone stock defects, we also use bone impaction grafting. We prospectively followed 130 patients with 175 cemented cups; no patients were lost to followup. The mean age of the patients at surgery was 31 years (range, 16–39 years). An acetabular reconstruction with bone impaction grafting was performed in 84 hips (48%). The minimum followup was 2 years (average, 8.1 years; range, 2.0–18.5 years). Twenty-one of the 175 cups (12%) were revised at an average of 8.1 years (range, 2.0–18.5 years). Reasons for revision were infection (one early, seven late), recurrent dislocations (two), traumatic loosening (one), and aseptic loosening (10). The 10-year survival rate of all cemented cups with end point of revision for any cause was 85%. Survival with end point of aseptic loosening of all cups was 92%. Survival with end point of revision for aseptic loosening was 90% for the cups without impaction grafting and 95% for the cups with impaction grafting. We believe cemented acetabular cups in young patients have acceptable midterm survival; however, in the case of acetabular bone defects, we recommend reconstruction with impaction grafting.

Level of Evidence - Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.