Acetabular fixation options: first-generation modular cup curtain calls and caveats

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Medical Device Engineering

Background:

• First-generation porous-coated acetabular cups were widely used in total hip arthroplasty.
• Assessing the long-term outcomes of these early designs is crucial for understanding implant performance.
• Modular hemispheric cups represent a significant advancement in hip implant technology.

Purpose of the Study:

• To review the 15-year clinical outcomes of three distinct types of modular, first-generation, porous-coated acetabular cups.
• To compare the survivorship rates of Arthopor, ACS Triloc+, and Harris-Galante cup designs.
• To identify factors influencing revision rates, including aseptic loosening and polyethylene wear.

Main Methods:

• Retrospective review of 910 primary total hip arthroplasties at a single institution.
• Analysis of implant survivorship using two endpoints: revision for any reason and revision for aseptic loosening.
• Statistical comparison of 15-year survivorship between the three cup designs (Arthropor, ACS Triloc+, Harris-Galante).

Main Results:

• Fifteen-year survivorship (revision for any reason) was 74.9% for Arthopor, 70.1% for ACS Triloc+, and 89.3% for Harris-Galante cups (P = .02).
• Aseptic loosening occurred in 20 of 168 acetabular revisions.
• Survivorship exceeded 95% at 15 years for all designs when using revision for aseptic loosening as the endpoint.

Conclusions:

• The Harris-Galante acetabular cup demonstrated superior 15-year survivorship compared to Arthopor and ACS Triloc+ designs.
• While polyethylene wear and occasional delamination necessitated revisions, aseptic loosening remained low across all three first-generation porous-coated cup types.
• Long-term performance data for early porous-coated acetabular components inform current orthopedic implant development and patient selection.