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Fixation & Cements

Polymethylmethacrylate (PMMA) fixation in hip arthroplasty, comparing cemented vs uncemented stems based on patient age, bone quality, and registry survivorship data.

Overview

Cementless components provide more durable fixation than cemented options in primary total hip arthroplasty [1], though cemented fixation remains an option for selected patients in revision settings with acceptable ten-year survival [10]. While all fixation techniques perform well at long-term follow-up, cemented fixation is associated with the lowest implant survival across all age groups, including the elderly [2]. Hybrid fixation using screws and cement represents the most reliable method for bispherical augments in acetabular defect reconstruction under full loads [8], whereas uncemented porous-coated anatomic femoral components show encouraging durability despite variable long-term function of uncemented acetabular components [23].

Specific techniques offer distinct advantages in complex scenarios. Retaining a well-fixed femoral cement mantle during cement-in-cement revision for infected hips eradicates infection and secures fixation in 92.1% of cases [3], a strategy that also provides reliable femoral fixation for elderly patients converting from hemiarthroplasty to total hip arthroplasty while potentially reducing operative time and complications [14]. Cement augmentation does not increase secondary fracture rates compared to nonoperative management in vertebral osteoporotic compression fractures [9], and bone cement requirements for kyphoplasty are excellently fulfilled regarding safety and properties [20]. Perioperative dexamethasone is associated with lower rates of pulmonary complications following cemented femoral fixation [25], while modular component exchange should be considered for recurrent dislocation to avoid the morbidity of revising well-fixed components [46].

Historical data notes that the first generation of Boneloc cement yielded poorer short-term results compared to other cements in primary Charnley prostheses [4].

Anatomy & Pathophysiology

Hip microinstability involves abnormal femoral head micromotion within the acetabulum, resulting in cartilage damage and osteoarthritis [38]. This condition frequently co-occurs with acetabular dysplasia or femoroacetabular impingement syndrome [38]. In revision total hip arthroplasty, a high hip center for an uncemented acetabular component does not adversely affect abductor muscle function but reduces mean limb-length discrepancy [63]. Conversely, a mismatch exists between the proximal femoral anatomy of many adult hips and the geometry of standard femoral components [53].

Risk Factors for Loosening: Male gender, Charnley class C status, and severity of bone defects predict aseptic loosening in the cup of ABG I hip arthroplasty [39]. Factors influencing bone bed quality and hip biomechanics may also contribute to this risk [39]. To mitigate instability during polyethylene liner and femoral head exchange, specific steps are required as complications are not uncommon [45].

Biomechanical Optimization: In femoral neck fractures treated with a femoral neck system, a positive buttress is more stable than a negative buttress when the Pauwels angle is 30° [43]. The biomechanical performance of this system is fracture-type-dependent, necessitating angle-specific optimization [44]. Robot-assisted total hip arthroplasty improves surgical accuracy without increasing trauma and better restores original hip biomechanics compared to manual techniques [42]. In dysplastic hips, a hook on an acetabular reinforcement ring effectively disperses stress and improves initial fixation strength [40].

Implant-Specific Considerations: A fenestration at the center of the femoral neck improves biomechanical gain and clinical outcomes in vascularized iliac bone flaps for femoral head necrosis [55]. Excellent clinical and radiographic results with a cemented custom-designed swan-neck femoral component were achieved in congenital dislocation or severe dysplasia, with a 94% survival rate at an average of 13.3 years [64]. The biomechanical objectives of this prosthesis were met in these complex cases [64]. For salvage of recurrently dislocating total hip prostheses, a constrained acetabular component provides durable protection against further dislocations without substantial deleterious effects on fixation [70].

Complications and Long-Term Outcomes: Repetitive extreme motion and implant malposition can cause impingement between the acetabular cup and femoral neck after hip resurfacing, though no significant factors explaining this impingement were identified [61]. Stability following proximal femoral endoprosthesis depends on variables related to the patient, pathology, surgical technique, and implant [60]. Symptoms and decreased function may emerge fifteen to twenty years after Colonna arthroplasty with concomitant femoral shortening and rotational osteotomy [58]. Results highlight the need to reconsider acetabular concept design to improve long-term survival and reduce loosening risk [65]. Intraoperative robotic-arm assisted placement correlates with postoperative implant position assessed via CT-based 3D modeling [67]. An interlocking reconstruction-mode stem-sideplate preserves native hip anatomy and function in primary and revision settings for large femoral resections with a short remaining proximal femur [69].

Classification

Vancouver: This system classifies periprosthetic femoral fractures, with specific modifications for cemented taper-slip components to subclassify B2 fractures into B2W (cement well-fixed) and B2L (cement loose) [12]. Treatment algorithms are defined by this classification: B1 fractures are treated by fixation, B2 by revision with a long stem, and B3 by complex reconstruction or prosthetic replacement [50]. While the choice between locking versus conventional plates for B1 fractures, or cemented versus cementless fixation for B2 and B3 fractures, does not significantly influence reoperation risk [41], the reliability of the Vancouver classification for cementless total hip arthroplasty is lower than previously described for cemented femoral stems [28].

Other Considerations: Cementless acetabular components demonstrate more durable fixation than cemented components in primary total hip arthroplasty [1], whereas cemented fixation is associated with the lowest implant survival across all age groups, including the elderly [2]. For revision scenarios, retaining a well-fixed femoral cement mantle during cement-in-cement revision for infected hip arthroplasty resulted in successful infection eradication and component fixation in 82 of 89 patients (92.1%) [3]. Both cementless modular metaphyseal fixation and cemented femoral fixation were successful at intermediate-term follow-up in Paprosky types I and II femoral bone during revision total hip arthroplasty [34]. Hybrid fixation using screws and cement is the most reliable method for bispherical augments in acetabular defect reconstruction, even under full loads [8]. The Exeter femoral stem design appears to compress the cement and the cement-bone interface, contributing to secure long-term fixation [6]. Regarding cement types, the first generation of Boneloc cement was associated with poorer short-term results compared to other types of cement in Charnley total hip prostheses [4]. While no significant difference was identified between two cementing techniques in Charnley total hip arthroplasty, the ability to deliver adequate cement around the femoral component was more predictable with the contemporary cementing technique [48]. A smart assistive bone-cement injection system exhibited more precise control of bone cement injection dosage and better cement distribution compared with traditional manual injection in a cadaveric study [52]. Finally, the choice of fixation type in total hip arthroplasty following femoral neck fracture in patients aged 65 and older should consider age, sex, comorbidities, bone quality, and surgical expertise [47].

Clinical Presentation

Fixation Durability: Cementless components demonstrate more durable fixation than cemented components in primary total hip arthroplasty [1]. Conversely, cemented fixation is associated with the lowest implant survival across all age groups, including the elderly [2]. While the first generation of Boneloc cement yielded poorer short-term results compared to other cements in Charnley prostheses [4], the Exeter femoral stem compresses the cement and cement-bone interface to contribute to secure long-term fixation [6]. At 15 years, all 143 proximally HA-coated tapered titanium femoral components remained well fixed and clinically asymptomatic [7].

Revision and Augmentation: Retaining a well-fixed femoral cement mantle during cement-in-cement revision for infected hip arthroplasty was successful in 82 of 89 patients (92.1%) regarding infection eradication and component fixation [3]. The cement-in-cement technique provides reliable femoral fixation in elderly populations undergoing revision of hemiarthroplasty to total hip arthroplasty and may reduce operating time and complication rates [14]. Revision with a cemented femoral component remains an option for selected patients in revision total hip arthroplasty, with an acceptable ten-year survival rate and fair radiographic evidence of fixation [10]. Hybrid fixation (screw and cement) is the most reliable method for bispherical augments in acetabular defect reconstruction, even under full loads [8].

Special Populations and Indications: Literature supports the use of a cemented femoral component in women older than 70 years of age, patients with femoral neck fractures, patients with a Dorr type C femur, and patients with severe osteoporosis [32]. Cemented fixation appears to be a superior option in instances of osteoporotic bone and should be considered in elderly patients, those with abnormal proximal femoral morphology, and those with inflammatory arthritis to mitigate periprosthetic fracture risk [18]. Poor short-term functional outcomes in the cementless group do not support their routine use for displaced femoral neck fractures in elderly patients [13]. While uncemented implants may be appropriate for patients at very high risk of bone cement implantation syndrome, pain and functional outcomes were assessed at the last follow-up in patients with neuromuscular diseases [16].

Radiographic and Complication Patterns: Among 21 cases with cementing grades B or C on postoperative x-ray, radiolucent lines (RLL) at the bone-cement interface disappeared before last follow-up in 11 cases [11]. The Vancouver system is modified to subclassify B2 periprosthetic fractures around cemented taper-slip femoral components into B2W (cement well-fixed) and B2L (cement loose) [12]. Complete removal of a migrated bone cement mass resolved femoral nerve compression pain after hip arthroplasty, though some sensory deficits may persist [30]. In osteoporotic bone, cement augmentation is the most important factor for pedicle screw fixation strength, while thread profile has little impact [31]. Cement augmentation does not increase the rate of secondary fracture after vertebral osteoporotic compression fracture compared with nonoperative management [9].

Alternative Fixation Modalities: Fixation technique had no influence on survivorship, mortality, or clinical and radiographic outcomes in the Rotaglide mobile-bearing total knee arthroplasty [5]. Coating a plate with antibiotic cement is a simple technique that may play a role in managing early infection after fracture fixation with retention of implants [17].

Investigations

Plain radiography: Radiographic assessment is critical for diagnosing aseptic loosening and evaluating fixation stability. For hemispheric porous-coated sockets, the most predictive findings for early loosening are the progression of radiolucent lines (RLL) more than two years after operation and any new RLL of 1 mm or wider appearing more than two years postoperatively [79]. In cementless total hip arthroplasty, the imaging approach for aseptic loosening of the acetabular cup does not rely on postoperative baseline or serial follow-up radiographs and can accurately determine the specific location of prosthetic loosening [68]. Regarding cemented stems, among 21 cases with cementing grades B or C, the radiolucent line at the bone-cement interface disappeared before last follow-up in 11 cases [11]. Higher bone cement volume in total knee arthroplasty was independently associated with a lower incidence of postoperative radiolucent lines [62]. The Vancouver system should be subclassified to distinguish B2 fractures into B2W (cement well-fixed) and B2L (cement loose) for periprosthetic fractures around cemented taper-slip femoral components [12]. However, the reliability of the Vancouver classification for cementless total hip arthroplasty is lower than previously described for cemented femoral stems [28].

Other Considerations: Clinical and radiographic outcomes after revision total hip arthroplasty for pelvic osteolysis with well-fixed cementless cups are favorable [76]. Revision of a stable component is not justifiable based on long duration of use, non-ideal position, or possible loosening on radiographs [29]. Cementless components demonstrated more durable fixation than cemented components in primary total hip arthroplasty [1], whereas cemented fixation was associated with the lowest implant survival in all age groups, including elderly patients, in total hip arthroplasty [2]. Cemented fixation appears superior in instances of osteoporotic bone and should be considered in elderly patients, those with abnormal proximal femoral morphology, and inflammatory arthritis to mitigate periprosthetic fracture risk [18]. The Exeter femoral stem appears to compress the cement and the cement-bone interface, contributing to secure long-term fixation [6]. At 15 years, all 143 proximally HA-coated tapered titanium femoral components remained well fixed and clinically asymptomatic [7]. Retaining a well-fixed femoral cement mantle during cement-in-cement revision for infected hip arthroplasty was successful in 82 of 89 patients (92.1%) regarding infection eradication and component fixation [3]. Revision with a cemented femoral component remains an option for selected patients in revision total hip arthroplasty, with an acceptable ten-year survival rate and fair radiographic evidence of fixation [10]. Hybrid fixation (cementless acetabular and cemented femoral components) resulted in lower rates of repeat revision and radiographic loosening for the acetabular component compared to fully cemented revisions in failed cemented total hip prosthesis [77]. Fixation technique had no influence on survivorship, mortality, or clinical and radiographic outcomes in the Rotaglide mobile-bearing total knee arthroplasty [5]. Hybrid fixation using screws and cement is the most reliable method for bispherical augments in acetabular defect reconstruction, even under full loads [8]. Screws with cement affordably repair a broad range of defect depths and orientations with great success in primary total knee arthroplasty [74]. Cement augmentation does not increase the rate of secondary fracture compared with nonoperative management in vertebral osteoporotic compression fractures [9].

Treatment

Operative

Implant Selection: Cementless acetabular components demonstrate more durable fixation than cemented components in primary total hip arthroplasty [1], whereas cemented fixation is associated with the lowest implant survival across all age groups, including the elderly [2]. For displaced femoral neck fractures in elderly patients, routine use of cementless fixation is not supported due to poor short-term functional outcomes, and a recent Cochrane analysis found no arguments favoring either non-cemented or cemented hemiarthroplasty [13, 54]. In contrast, standard cemented femoral stems remain reliable and cost-effective for total hip replacement following failed internal fixation of intertrochanteric femoral fractures [36]. A hybrid approach, inserting an acetabular component without cement and a femoral component with cement, is encouraged for elderly patients and young patients with femoral osteoporosis, provided an adequate cement mantle is achieved in the proximal femur [35]. Regarding shoulder arthroplasty, both cemented and press-fit humeral fixation techniques yield durable improvements in function with similar 10-year survival rates [22].

Revision: Revision with a cemented femoral component remains a viable option for selected patients in revision total hip arthroplasty, offering an acceptable ten-year survival rate and fair radiographic evidence of fixation [10]. The cement-in-cement technique provides reliable femoral fixation in elderly patients undergoing revision of hemiarthroplasty to total hip arthroplasty and may reduce operating time and complication rates [14]. Retaining a well-fixed femoral cement mantle during cement-in-cement revision for infected hip arthroplasty was successful in 82 of 89 patients (92.1%) regarding infection eradication and component fixation [3]. Similarly, cement-within-cement fixation of the humeral component in revision reverse shoulder arthroplasty is associated with reasonable operative time, good medium-term survival, pain relief, functional outcomes, and low complications [15]. This technique effectively improves functional outcome scores and shoulder range of motion in the same population [33].

Technique & Adjuncts: The French Paradox cementing philosophy may reduce migration into retroversion, wear, and cement deformation, contributing to good long-term fixation and implant survival [24]. No cementing technique for hip resurfacing is perfect, though the cement-packing technique offers the best opportunity to control cement mantle quality despite persistent interfacial gaps [72]. In vertebral osteoporotic compression fractures, cement augmentation does not increase the rate of secondary fracture compared with nonoperative management [9], and requirements for bone cement in a kyphoplasty setting are excellently fulfilled regarding properties and clinical application safety [20]. Coating a plate with antibiotic cement is a simple technique that may play a role in managing early infection after fracture fixation with retention of implants [17]. Perioperative dexamethasone is associated with lower rates of pulmonary complications following cemented femoral fixation during primary total hip arthroplasty [25].

Outcomes & Considerations: Fixation technique had no influence on survivorship, mortality, or clinical and radiographic outcomes in the Rotaglide mobile-bearing total knee arthroplasty [5]. Proximal debonding of the cement mantle or non-union of the greater trochanter precedes fatigue fracture of a forged cobalt-chromium-molybdenum femoral component inserted with cement [71]. Three described methods of managing intraoperative nondisplaced calcar fractures demonstrated little radiographic stem subsidence, but the risk of reoperation was much higher than expected [56]. Revision of a stable component is not justifiable based on its long duration in use, non-ideal position, or possible loosening on radiographs [29].

Complications

Aseptic loosening: Cementless components demonstrate more durable fixation than cemented components in primary total hip arthroplasty [1], with cemented fixation associated with the lowest implant survival across all age groups [2]. While the first generation of Boneloc cement yielded poorer short-term results compared to other cements in Charnley prostheses [4], contemporary cementless acetabular components relying on biologic fixation show lower rates of radiographic loosening at 10 years than cemented counterparts [21]. Long-term results for revision hip arthroplasty without cement are encouraging and compare favorably with cemented revisions [26]. For specific implants, long-term outcomes in total knee arthroplasty are not expected to be influenced by the fixation type [19], and the fixation technique does not impact survivorship or clinical outcomes for the Rotaglide mobile-bearing total knee arthroplasty [5].

Polyethylene wear: Minimum 10-year follow-up confirms durable fixation and reduced wear for contemporary acetabular components and cross-linked polyethylene in patients aged 50 and under [27]. A lower rate of migration into retroversion may reduce wear and cement deformation, contributing to good long-term fixation and implant survival [24]. Excellent fixation and low wear were demonstrated at 10 years using a cementless acetabular construct with a moderately cross-linked polyethylene liner [66].

Bone Cement Implantation Syndrome (BCIS): Historical data indicates that cemented hemiarthroplasty carries a risk of BCIS and early mortality [51]. An uncemented implant remains an appropriate option for patients at very high risk of BCIS [16].

Other Considerations: The Exeter femoral stem appears to compress the cement and the cement-bone interface, contributing to secure long-term fixation [6]. At 15 years, all 143 proximally HA-coated tapered titanium femoral components remained well fixed and clinically asymptomatic [7]. Among 21 revision total hip arthroplasty cases with interface bioactive bone cement showing grade B or C radiolucent lines, the lines disappeared before last follow-up in 11 cases [11]. Cement-within-cement fixation of the humeral component in revision reverse shoulder arthroplasty is associated with reasonable operative time, good medium-term survival, pain relief, functional outcomes, and low complications [15]. Contemporary long cemented revision stems are associated with a low risk for femoral re-revision at 10 years in revision total hip arthroplasty, independent of demographics or surgical factors [57]. A detailed history, careful examination, and plain radiographs provide the most useful information for evaluating pain in patients with apparently solidly fixed total hip arthroplasty components [59].

Recovery

Light activity (weeks): Evidence regarding specific week ranges for light activity or driving is not provided in the current evidence base. However, cement-within-cement fixation in revision reverse shoulder arthroplasty is associated with reasonable operative time and good medium-term survival rates [15], while direct exchange arthroplasty for infection can yield success comparable to delayed exchange if antibiotic-loaded cement and appropriate postoperative antibiotics are used [73].

Full activity (months): The evidence does not specify month ranges for full activity or manual work return. Regarding functional outcomes, both cemented and press-fit humeral fixation techniques yield durable and significant improvements in shoulder function with similar rates of survival at 10 years of follow-up [22]. For the implant studied in the randomized RSA controlled trial, the long-term outcome is not expected to be influenced by the type of fixation to the bone [19].

Complete recovery / outcome plateau (months): Cementless components demonstrated more durable fixation than cemented components in primary total hip arthroplasty [1], whereas cemented fixation was associated with the lowest implant survival in all age groups, including elderly patients, in total hip arthroplasty [2]. At 15 years, all 143 proximally HA-coated tapered titanium femoral components remained well fixed and clinically asymptomatic [7]. Long-term results of revision hip arthroplasty done without cement are encouraging and compare favorably with those of revision with cement [26]. Minimum 10-year follow-up demonstrated durable fixation and reduced wear for contemporary acetabular components and cross-linked polyethylene in patients aged 50 and under [27]. Cemented total hip implants in patients under 30 years have an encouraging outcome at 10 and 15 years after surgery [75].

Rehabilitation protocol: The Exeter femoral stem appears to compress the cement and the cement bone interface, contributing to secure fixation in the long term [6]. Among 21 cases of revision total hip arthroplasty with interface bioactive bone cement assessed as grade B or C, radiolucent lines at the bone-cement interface disappeared before last follow-up in 11 cases [11]. At a mean of seven years, fixation of porous-coated acetabular components with screw fixation was uniformly excellent with no loosening [78]. Fixation technique had no influence on survivorship, mortality, or clinical and radiographic outcomes for the Rotaglide mobile-bearing total knee arthroplasty [5].

Functional milestones: The first generation of Boneloc cement was associated with poorer short-term results than other types of cement in Charnley total hip prostheses [4]. Poor short-term functional outcomes in the cementless group do not support their routine use for displaced femoral neck fractures in elderly patients [13]. The durability of femoral fixation for the porous-coated anatomic total hip prosthesis inserted without cement is encouraging, but not all acetabular components fixed without cement function well over the long term [23]. Cementless acetabular components relying on biologic fixation can have lower rates of radiographic loosening at 10 years compared with cemented components [21].

Key Evidence

  • [L3] Cementless components had more durable fixation than cemented components. (10.1016/j.arth.2007.11.010)
  • [L3] While all fixation techniques performed well at long-term follow-up, cemented fixation was associated with the lowest implant survival in all age groups, including in more elderly patients. (10.1302/0301-620x.104b2.bjj-2021-1199.r1)
  • [L4] Retaining a well-fixed femoral cement mantle in the presence of infection and undertaking a cement-in-cement revision was successful in 82 of the patients (92.1%) in terms of eradication of infection and component fixation. (10.1302/0301-620x.104b2.bjj-2021-0598.r1)
  • [L3] The first generation of Boneloc cement was associated with poorer short-term results than other types of cement. (10.2106/00004623-199510000-00009)
  • [L2] The fixation technique had no influence on survivorship, mortality, or clinical and radiographic outcomes. (10.1007/s00167-013-2829-9)
  • [L2] This appears to compress the cement and the cement bone interface, contributing to secure fixation in the long term. (10.1302/0301-620x.95b5.31330)
  • [L3] At 15 years, all 143 implants remained well fixed and clinically asymptomatic. (10.1007/s11999-008-0550-7)
  • [L5] The hybrid fixation (screw and cement) is the most reliable method, even under full loads. (10.1186/s12891-025-09006-y)
  • [L3] Cement augmentation does not increase the rate of secondary fracture compared with nonoperative management. (10.2106/jbjs.22.00469)
  • [L4] Among 21 cases whose cementing grade was assessed as B or C in postoperative x-ray, RLL at bone-cement interface has disappeared before last follow-up in 11 cases. (10.1016/j.arth.2007.05.042)
  • [L4] The authors endorse a modification of the Vancouver system to subclassify B2 fractures into B2W (cement well-fixed) and B2L (cement loose). (10.1302/0301-620x.103b1.bjj-2020-0163.r1)
  • [L1] However, due to the poor short-term functional outcomes in the cementless group, the findings do not support their routine use in the treatment of these elderly patients. (10.1302/0301-620x.100b8.bjj-2017-1593.r1)
  • [L4] The cement-in-cement technique provides reliable femoral fixation in this elderly population and may reduce operating time and rates of complication. (10.1302/0301-620x.97b12.35814)
  • [L4] Cement-within-cement fixation of the humeral component in revision reverse shoulder arthroplasty is associated with a reasonable operative time, good medium-term survival rates, and good pain relief and functional outcomes with low complications. (10.1016/j.jse.2017.01.013)
  • [Letter] The authors clarify that pain and functional outcomes were assessed at the last follow-up, confirm that all surgeries were performed by experienced surgeons or residents supervised by experienced surgeons, and note that while intraoperative death was not detected, an uncemented implant may still be appropriate for patients at very high risk of bone cement implantation syndrome. (10.1186/s13018-021-02674-1)
  • [L4] Coating the plate with antibiotic cement is a simple technique which may play a role in the management of early infection after fracture fixation. (10.1186/s12891-018-2285-2)
  • [L4] Cemented fixation appears to be a superior option in certain instances, predominately with osteoporotic bone, and should be considered in elderly patients, those with abnormal proximal femoral morphology, and inflammatory arthritis to mitigate the risk of periprosthetic fractures. (10.5435/jaaos-d-19-00604)
  • [L1] For this implant, the long-term outcome is not expected to be influenced by the type of fixation to the bone. (10.1302/0301-620x.103b1.bjj-2020-0788.r1)
  • [L4] Requirements for bone cement in a kyphoplasty setting were excellently fulfilled. (10.1186/s13018-019-1200-3)
  • [L5] Cementless acetabular components that rely on biologic fixation can have lower rates of radiographic loosening at 10 years compared with cemented components, suggesting that biologic fixation through bone ingrowth may provide more durable long-term implant survival. (10.5435/00124635-200201000-00007)
  • [L3] Both cemented and press-fit humeral fixation techniques yield durable and significant improvements in shoulder function with similar rates of survival at 10 years of follow-up. (10.1016/j.jse.2023.11.029)
  • [L3] The durability of the femoral fixation is encouraging, but not all acetabular components fixed without cement function well over the long term, warranting specific design considerations such as adequate initial fixation and a smaller femoral head. (10.2106/00004623-199901000-00011)
  • [L1] However, the lower rate of migration into retroversion may reduce the wear and cement deformation, contributing to good long-term fixation and implant survival. (10.1302/0301-620x.104b1.bjj-2021-0325.r2)
  • [L3] Orthopaedic surgeons utilizing cement fixation in THA should consider the utilization of perioperative DEX. (10.1016/j.arth.2025.03.069)
  • [L3] These long-term results of revision hip arthroplasty without cement are encouraging and compare favorably with those of revision with cement. (10.2106/00004623-199407000-00002)
  • [L3] The reliability of the Vancouver classification for cementless total hip arthroplasty is lower than previously described in cemented femoral stems. (10.1016/j.arth.2019.02.062)
  • [L5] Complete removal of the cement mass resolved the pain, though some sensory deficits may persist. (10.1016/j.arth.2011.02.030)
  • [L5] In osteoporotic bone, cement augmentation is the most important factor for fixation strength, while thread profile has little impact. (10.1371/journal.pone.0229328)
  • [L2] The literature supports the use of a cemented femoral component in women older than 70 years of age, in patients who have femoral neck fractures, in patients who have a Dorr type C femur, and in patients who have severe osteoporosis. (10.1016/j.arth.2024.10.034)
  • [L3] Use of the cement-within-cement technique for fixation of the humeral component in revision RSA is effective in improving functional outcome scores and shoulder range of motion. (10.1016/j.jse.2020.01.094)
  • [L2] Cementless, modular metaphyseal fixation and cemented femoral fixation were both successful at intermediate-term follow-up in Paprosky types I and II femoral bone. (10.1016/j.arth.2007.06.009)
  • [L3] They encourage the use of this technique in elderly patients and young patients with femoral osteoporosis, while cautioning the need for an adequate cement mantle in the proximal femur. (10.2106/00004623-199605000-00009)
  • [L4] Standard cemented femoral stems are reliable and cost-effective prostheses in such cases. (10.1016/j.arth.2020.04.021)
  • [L3] Factors potentially associated with the quality of bone bed and biomechanics of the hip might influence the risk of aseptic loosening in this implant. (10.1186/1471-2474-11-243)
  • [Paper] In biomechanical analyses, the hook effectively dispersed stress and improved the initial fixation strength of the acetabular reinforcement ring. (10.1186/s13018-018-1023-7)
  • [L3] The choice of locking or conventional plates for the treatment of type B1, and cemented or cementless femoral components fixation for B2 and B3 fractures, had no significant influence on risk for reoperation. (10.1302/0301-620x.101b11.bjj-2019-0480.r2)
  • [L1] Compared to manual THA, R-THA improves surgical accuracy without increasing surgical trauma, contributing to the restoration of the patient's original hip biomechanics. (10.1016/j.arth.2025.07.029)
  • [L5] From the perspective of biomechanics, when the Pauwels angle was 30°, positive buttress was more stable to negative buttress. (10.1186/s12891-022-06124-9)
  • [Paper] The biomechanical performance of the FNS is fracture-type-dependent, necessitating angle-specific optimisation. (10.1186/s12891-026-09591-6)
  • [L4] Complications are not uncommon, and steps should be taken to mitigate hip instability. (10.2106/jbjs.18.00522)
  • [L4] This method should be considered because it avoids the morbidity associated with revision of well-fixed components. (10.2106/00004623-200110000-00011)
  • [L3] Fixation type choice should consider various factors, including age, sex, comorbidities, bone quality, and surgical expertise. (10.1016/j.arth.2024.01.034)
  • [L3] While no significant difference between the two cementing techniques could be identified, the ability to deliver adequate cement around the femoral component was more predictable with the contemporary cementing technique. (10.2106/00004623-200112000-00012)
  • [L5] The paper presents a method to investigate the effect of different implant positions on the biomechanics of the knee after total knee arthroplasty using a VIVO joint simulator without modifying the physical setup. (10.1186/s42836-025-00351-w)
  • [L5] The correct approach depends on the Vancouver classification, with B1 fractures treated by fixation, B2 by revision with a long stem, and B3 by complex reconstruction or prosthetic replacement. (10.1302/0301-620x.96b11.34300)
  • [Letter] The authors critique a referenced study for lacking details on pain evaluation, blood loss calculation, and surgical standardization, and argue that while the referenced study found no intraoperative deaths, historical data suggests cemented hemiarthroplasty carries a risk of Bone Cement Implantation Syndrome (BCIS) and early mortality, recommending uncemented implants for this population. (10.1186/s13018-021-02670-5)
  • [L5] The system exhibited more precise control of the bone cement injection dosage and better cement distribution compared with traditional manual injection. (10.1186/s13018-025-05680-9)
  • [L4] The present study revealed a mismatch between proximal femoral anatomy of a relevant proportion of adult hips and implant geometry of the most common femoral component in total hip arthroplasty. (10.1016/j.arth.2016.02.015)
  • [L2] A recent Cochrane analysis did not find arguments in favour of either non-cemented or cemented hemiarthroplasty. (10.1186/1471-2474-10-56)
  • [L4] A fenestration at the center of the femoral neck resulted in improved biomechanical gain and clinical outcomes. (10.1186/s13018-024-05390-8)
  • [L3] The three described methods of managing intraoperative nondisplaced calcar fractures demonstrated little radiographic stem subsidence; however, the risk of reoperation was much higher than expected. (10.1016/j.arth.2024.03.049)
  • [L4] Contemporary long cemented revision stems were associated with a low risk for femoral re-revision at 10 years, with no influence of demographics, cause for revision, or surgical factors. (10.1016/j.arth.2025.11.011)
  • [L4] However, increasing symptoms and decreased function related to degenerative hip disease may occur fifteen to twenty years after the procedure. (10.2106/00004623-199701000-00009)
  • [L5] A detailed history, careful examination, and plain radiographs provide the most useful information for evaluating pain in patients with apparently solidly fixed total hip arthroplasty components. (10.5435/00124635-200203000-00004)
  • [L3] Stability of the hip after PFA is influenced by variables associated with the patient, the pathology, the surgical technique and the implant. (10.1302/0301-620x.99b4.bjj-2016-0960.r1)
  • [L4] Although no significant factors were found to explain the impingement, it appears that repetitive extreme motion of the involved hip and malposition of the implants can cause impingement after hip resurfacing arthroplasty. (10.2106/jbjs.j.01771)
  • [L3] Higher bone cement volume was independently associated with a lower incidence of radiolucent lines. (10.1002/ksa.12582)
  • [L4] The use of a high hip center did not adversely affect function of the abductor muscles, and the mean limb-length discrepancy was reduced by the femoral reconstruction. (10.2106/00004623-199904000-00004)
  • [L4] The excellent clinical and radiographic results associated with the swan-neck femoral component, and the 94% rate of survival, at an average of 13.3 years indicate that the biomechanical objectives of this custom-designed prosthesis for patients with congenital dislocation or severe hip dysplasia were met. (10.2106/00004623-200202000-00006)
  • [L5] These results, consistent with clinical observations, highlight the need to reconsider acetabular concept design to improve long-term survival rates and reduce the risk of loosening. (10.1016/j.arth.2025.12.017)
  • [L4] The overall hip reconstruction obtained in the operating theatre using robotic assistance accurately correlated with the postoperative component position assessed independently using CT based 3D modelling. (10.1302/0301-620x.100b10-bjj-2018-0201.r1)
  • [L4] This approach does not rely on postoperative baseline radiographs or serial follow-up radiographs and can accurately determine the specific location of prosthetic loosening. (10.1186/s12891-025-08607-x)
  • [L4] This interlocking, reconstruction-mode stem-sideplate reliably preserves native hip joint anatomy and function after large femoral resection with a short remaining proximal femur, both in the primary and revision setting. (10.1302/0301-620x.103b2.bjj-2020-0654.r1)
  • [L4] The constrained acetabular component provides durable protection against additional dislocations without substantial deleterious effects on component fixation. (10.2106/00004623-200411000-00009)
  • [L4] Proximal debonding of the cement mantle or non-union of the greater trochanter precedes fatigue fracture of the stem; patients with radiographic evidence of debonding should be followed closely and counseled about prophylactic revision. (10.2106/00004623-199712000-00010)
  • [L5] None of the cementing techniques was perfect; the cement-packing technique offered the best opportunity to control the quality of the cement mantle, though interfacial gaps remained. (10.2106/jbjs.i.00322)
  • [L4] The experience suggests that direct exchange can yield a rate of success comparable with that of delayed exchange if antibiotic-loaded cement and appropriate postoperative antibiotics are used. (10.2106/00004623-199807000-00004)
  • [L3] Cemented total hip implants in patients under 30 years have an encouraging outcome at 10 and 15 years after surgery in these young patients. (10.1186/1471-2474-14-37)
  • [L3] Clinical and radiographic outcomes after revision THA for pelvic osteolysis with well-fixed cementless cups are favorable. (10.1016/j.arth.2007.05.049)
  • [L3] Hybrid fixation (cementless acetabular and cemented femoral components) resulted in lower rates of repeat revision and radiographic loosening for the acetabular component compared to fully cemented revisions. (10.2106/00004623-199607000-00002)
  • [L3] At a mean of seven years, fixation of this porous-coated component was uniformly excellent with no loosening. (10.2106/00004623-199607000-00001)
  • [L3] The most predictive radiographic findings for early diagnosis of loosening were progression of radiolucent lines more than two years after the operation and any new radiolucent line of 1 mm or wider that appeared more than two years postoperatively. (10.2106/00004623-200112000-00015)

References

[1] A Comparison of the Outcome of Cemented All-Polyethylene and Cementless Metal-Backed Acetabular Sockets in Primary Total Hip Arthroplasty. The Journal of Arthroplasty. 2009. DOI: 10.1016/j.arth.2007.11.010

[2] Should patient age thresholds dictate fixation strategy in total hip arthroplasty?. The Bone & Joint Journal. 2022. DOI: 10.1302/0301-620x.104b2.bjj-2021-1199.r1

[3] Cement-in-cement revision of the femur in infected hip arthroplasty in 89 patients across two centres. The Bone & Joint Journal. 2022. DOI: 10.1302/0301-620x.104b2.bjj-2021-0598.r1

[4] The effect of the type of cement on early revision of Charnley total hip prostheses. A review of eight thousand five hundred and seventy-nine primary arthroplasties from the Norwegian Arthroplasty Register.. The Journal of Bone & Joint Surgery. 1995. DOI: 10.2106/00004623-199510000-00009

[5] The Rotaglide mobile‐bearing total knee arthroplasty: no difference between cemented and hybrid implantation. Knee Surgery, Sports Traumatology, Arthroscopy. 2014. DOI: 10.1007/s00167-013-2829-9

[6] Ten-year RSA-measured migration of the Exeter femoral stem. The Bone & Joint Journal. 2013. DOI: 10.1302/0301-620x.95b5.31330

[7] Late Remodeling Around a Proximally HA-coated Tapered Titanium Femoral Component. Clinical Orthopaedics & Related Research. 2009. DOI: 10.1007/s11999-008-0550-7

[8] Biomechanical evaluation of bispherical augments in acetabular defect reconstruction and comparative study of different fixation methods. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-09006-y

[9] Secondary Fracture Rate After Vertebral Osteoporotic Compression Fracture Is Decreased by Anti-Osteoporotic Medication but Not Increased by Cement Augmentation. Journal of Bone and Joint Surgery. 2022. DOI: 10.2106/jbjs.22.00469

[10] A Prospective Outcomes Analysis of Femoral Component Fixation in Revision Total Hip Arthroplasty Comparing Modular, Cementless Fixation with Cemented Femoral Fixation. 2006.

[11] Radiological Evaluation of the Femoral Component Fixed with Interface Bioactive Bone Cement in Revision Total Hip Arthroplasty. The Journal of Arthroplasty. 2008. DOI: 10.1016/j.arth.2007.05.042

[12] B2 or not B2? That is the question: a review of periprosthetic fractures around cemented taper-slip femoral components. The Bone & Joint Journal. 2021. DOI: 10.1302/0301-620x.103b1.bjj-2020-0163.r1

[13] A randomized controlled trial of cementedversuscementless arthroplasty in patients with a displaced femoral neck fracture. The Bone & Joint Journal. 2018. DOI: 10.1302/0301-620x.100b8.bjj-2017-1593.r1

[14] Revision of hemiarthroplasty to total hip arthroplasty using the cement-in-cement technique. The Bone & Joint Journal. 2015. DOI: 10.1302/0301-620x.97b12.35814

[15] Cement-within-cement technique in revision reverse shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2017.01.013

[16] In reply to the letter to the editor regarding “Cemented versus uncemented hemiarthroplasty for femoral neck fractures in patients with neuromuscular diseases: a minimum of 2 years’ follow-up study”. Journal of Orthopaedic Surgery and Research. 2021. DOI: 10.1186/s13018-021-02674-1

[17] Coating the plate with antibiotic cement to treat early infection after fracture fixation with retention of the implants: a technical note. BMC Musculoskeletal Disorders. 2018. DOI: 10.1186/s12891-018-2285-2

[18] The Use of Cement in Hip Arthroplasty: A Contemporary Perspective. Journal of the American Academy of Orthopaedic Surgeons. 2020. DOI: 10.5435/jaaos-d-19-00604

[19] What is the role of cemented fixation in total knee arthroplasty? The two-year results of a randomized RSA controlled trial. The Bone & Joint Journal. 2021. DOI: 10.1302/0301-620x.103b1.bjj-2020-0788.r1

[20] Properties and clinical application safety of antibiotic-loaded bone cement in kyphoplasty. Journal of Orthopaedic Surgery and Research. 2019. DOI: 10.1186/s13018-019-1200-3

[21] The Optimal Fixation of the Cementless Acetabular Component in Primary Total Hip Arthroplasty. Journal of the American Academy of Orthopaedic Surgeons. 2002. DOI: 10.5435/00124635-200201000-00007

[22] Cemented vs. press-fit humeral stems: a matched cohort analysis at a mean follow-up of 10 years. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2023.11.029

[23] The Porous-Coated Anatomic Total Hip Prosthesis, Inserted without Cement. A Prospective Study with a Minimum Ten Years of Follow-up. The Journal of Bone & Joint Surgery*. 1999. DOI: 10.2106/00004623-199901000-00011

[24] Is the French Paradox cementing philosophy superior to the standard cementing? A randomized controlled radiostereometric trial and comparative analysis. The Bone & Joint Journal. 2022. DOI: 10.1302/0301-620x.104b1.bjj-2021-0325.r2

[25] Dexamethasone Is Associated With Lower Rates of Pulmonary Complications Following Cemented Femoral Fixation During Primary Total Hip Arthroplasty. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.03.069

[26] Outcome of revision hip arthroplasty done without cement.. The Journal of Bone & Joint Surgery. 1994. DOI: 10.2106/00004623-199407000-00002

[27] Fixation_and_Wear_With_Contemporary_Acetabular_Components_and_Cross-Linked_Polye_S0883540315003769. n.d..

[28] Reliability and Validity of the Vancouver Classification in Periprosthetic Fractures Around Cementless Femoral Stems. The Journal of Arthroplasty. 2019. DOI: 10.1016/j.arth.2019.02.062

[29] One-Component_Revision_in_Total_Hip_Arthroplasty_The_Fate_of_the_Retained_Compon_S088354031400312X. n.d..

[30] Femoral Nerve Compression After Migration of Bone Cement to the Groin After Hip Arthroplasty. The Journal of Arthroplasty. 2011. DOI: 10.1016/j.arth.2011.02.030

[31] Biomechanical comparison of pedicle screw fixation strength in synthetic bones: Effects of screw shape, core/thread profile and cement augmentation. PLOS ONE. 2020. DOI: 10.1371/journal.pone.0229328

[32] In Which Patients Should Cemented Femoral Components Be Used During Primary Total Hip Arthroplasty?. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2024.10.034

[33] Optimizing humeral stem fixation in revision reverse shoulder arthroplasty with the cement-within-cement technique. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2020.01.094

[34] A Prospective Outcomes Analysis of Femoral Component Fixation in Revision Total Hip Arthroplasty. The Journal of Arthroplasty. 2008. DOI: 10.1016/j.arth.2007.06.009

[35] Primary Total Hip Replacement with Insertion of an Acetabular Component without Cement and a Femoral Component with Cement. Follow-up Study at an Average of Six Years. The Journal of Bone & Joint Surgery*. 1996. DOI: 10.2106/00004623-199605000-00009

[36] The Use of Standard Cemented Femoral Stems in Total Hip Replacement After Failed Internal Fixation of Intertrochanteric Femoral Fractures. The Journal of Arthroplasty. 2020. DOI: 10.1016/j.arth.2020.04.021

[38] Chapter 12 Hip Microinstability. 2019.

[39] Male gender, Charnley class C, and severity of bone defects predict the risk for aseptic loosening in the cup of ABG I hip arthroplasty. BMC Musculoskeletal Disorders. 2010. DOI: 10.1186/1471-2474-11-243

[40] Acetabular reinforcement ring with additional hook improves stability in three-dimensional finite element analyses of dysplastic hip arthroplasty. Journal of Orthopaedic Surgery and Research. 2018. DOI: 10.1186/s13018-018-1023-7

[41] Surgical treatment of Vancouver type B periprosthetic femoral fractures. The Bone & Joint Journal. 2019. DOI: 10.1302/0301-620x.101b11.bjj-2019-0480.r2

[42] Robot-Assisted Total Hip Arthroplasty Versus Conventional Surgery in Terms of Surgical Accuracy, Function, Trauma, and Complications: A Prospective, Multicenter, Parallel-Group, Open-Label Randomized Controlled Trial. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2025.07.029

[43] Biomechanical study of femoral neck system for young patients with nonanatomically reduced femoral neck fractures: a finite element. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-022-06124-9

[44] Finite element analysis of the influence of femoral neck system implantation angle on biomechanical stability in femoral neck fractures: a mechanistic exploration. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09591-6

[45] Polyethylene Liner and Femoral Head Exchange in Total Hip Arthroplasty. Journal of Bone and Joint Surgery. 2019. DOI: 10.2106/jbjs.18.00522

[46] Modular Component Exchange for Treatment of Recurrent Dislocation of a Total Hip Replacement in Selected Patients. The Journal of Bone and Joint Surgery-American Volume. 2001. DOI: 10.2106/00004623-200110000-00011

[47] Cemented Versus Cementless Femoral Fixation for Total Hip Arthroplasty Following Femoral Neck Fracture in Patients Aged 65 and Older. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2024.01.034

[48] Charnley Total Hip Arthroplasty with Use of Improved Cementing Techniques. The Journal of Bone and Joint Surgery-American Volume. 2001. DOI: 10.2106/00004623-200112000-00012

[49] Methodology for biomechanical investigation of implant malpositioning in total knee arthroplasty using a six degree of freedom joint simulator. Arthroplasty. 2025. DOI: 10.1186/s42836-025-00351-w

[50] Periprosthetic fractures. The Bone & Joint Journal. 2014. DOI: 10.1302/0301-620x.96b11.34300

[51] Letter to the Editor: Cemented versus uncemented hemiarthroplasty for femoral neck fractures in patients with neuromuscular diseases: a minimum of 2 years’ follow-up study. Journal of Orthopaedic Surgery and Research. 2021. DOI: 10.1186/s13018-021-02670-5

[52] Safety and feasibility of a smart assistive bone-cement injection system: a cadaveric study. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-05680-9

[53] Agreement Between Proximal Femoral Geometry and Component Design in Total Hip Arthroplasty: Implications for Implant Choice. The Journal of Arthroplasty. 2016. DOI: 10.1016/j.arth.2016.02.015

[54] Cemented versus non-cemented hemiarthroplasty of the hip as a treatment for a displaced femoral neck fracture: design of a randomised controlled trial. BMC Musculoskeletal Disorders. 2009. DOI: 10.1186/1471-2474-10-56

[55] Biomechanical and clinically controlled study of different fenestration positions in vascularized iliac bone flaps for treating femoral head necrosis. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-024-05390-8

[56] Three Differing Methods of Treating Intraoperative Nondisplaced Calcar Fractures Demonstrate Similar Radiographic Stem Subsidence. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2024.03.049

[57] Contemporary Cemented Revision Stems Demonstrate Excellent Survivorship in Revision Total Hip Arthroplasty up to 13-Year Follow-Up. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.11.011

[58] Colonna Arthroplasty with Concomitant Femoral Shortening and Rotational Osteotomy. Long-Term Results. The Journal of Bone and Joint Surgery-American Volume*. 1997. DOI: 10.2106/00004623-199701000-00009

[59] Evaluation of Pain in Patients With Apparently Solidly Fixed Total Hip Arthroplasty Components. Journal of the American Academy of Orthopaedic Surgeons. 2002. DOI: 10.5435/00124635-200203000-00004

[60] The stability of the hip after the use of a proximal femoral endoprosthesis for oncological indications. The Bone & Joint Journal. 2017. DOI: 10.1302/0301-620x.99b4.bjj-2016-0960.r1

[61] Impingement Between the Acetabular Cup and the Femoral Neck After Hip Resurfacing Arthroplasty. Journal of Bone and Joint Surgery. 2011. DOI: 10.2106/jbjs.j.01771

[62] Higher bone cement volume in total knee arthroplasty lowers the risk of postoperative radiolucent lines. Knee Surgery, Sports Traumatology, Arthroscopy. 2025. DOI: 10.1002/ksa.12582

[63] High Placement of an Acetabular Component Inserted without Cement in a Revision Total Hip Arthroplasty. Results After a Mean of Ten Years. The Journal of Bone & Joint Surgery*. 1999. DOI: 10.2106/00004623-199904000-00004

[64] Long-Term Results of Total Hip Arthroplasty with a Cemented Custom-Designed Swan-Neck Femoral Component for Congenital Dislocation or Severe Dysplasia. The Journal of Bone and Joint Surgery-American Volume. 2002. DOI: 10.2106/00004623-200202000-00006

[65] Predicting Acetabular Fixation Failure and Bone Loss in Total Hip Arthroplasty: A Combined In Silico and In Vitro Approach. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.12.017

[66] Fixation_and_Wear_With_a_Contemporary_Acetabular_Component_and_Cross-Linked_Poly_S0883540314003155. n.d..

[67] Intraoperative placement of total hip arthroplasty components with robotic-arm assisted technology correlates with postoperative implant position. The Bone & Joint Journal. 2018. DOI: 10.1302/0301-620x.100b10-bjj-2018-0201.r1

[68] Imaging study of aseptic loosening of the acetabular cup after cementless total hip arthroplasty: a retrospective study. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08607-x

[69] Interlocking reconstruction-mode stem-sideplates preserve at-risk hips with short residual proximal femora. The Bone & Joint Journal. 2021. DOI: 10.1302/0301-620x.103b2.bjj-2020-0654.r1

[70] Salvage of a Recurrently Dislocating Total Hip Prosthesis with Use of a Constrained Acetabular Component: A Concise Follow-up of a Previous Report. The Journal of Bone and Joint Surgery-American Volume*. 2004. DOI: 10.2106/00004623-200411000-00009

[71] Fatigue Fracture of a Forged Cobalt-Chromium-Molybdenum Femoral Component Inserted with Cement. A Report of Ten Cases. The Journal of Bone & Joint Surgery*. 1997. DOI: 10.2106/00004623-199712000-00010

[72] Influence of the Cementing Technique on the Cement Mantle in Hip Resurfacing. The Journal of Bone & Joint Surgery. 2010. DOI: 10.2106/jbjs.i.00322

[73] Direct-Exchange Arthroplasty for the Treatment of Infection after Total Hip Replacement. An Average Ten-Year Follow-up. The Journal of Bone & Joint Surgery*. 1998. DOI: 10.2106/00004623-199807000-00004

[74] Use_of_Screws_and_Cement_in_Primary_TKA_with_Up_to_20Years_Follow-Up_S0883540313009133. n.d..

[75] Long-term results of cemented total hip arthroplasty in patients younger than 30 years and the outcome of subsequent revisions. BMC Musculoskeletal Disorders. 2013. DOI: 10.1186/1471-2474-14-37

[76] Revision Total Hip Arthroplasty for Pelvic Osteolysis With Well-Fixed Cementless Cup. The Journal of Arthroplasty. 2007. DOI: 10.1016/j.arth.2007.05.049

[77] Revision of a Failed Cemented Total Hip Prosthesis with Insertion of an Acetabular Component without Cement and a Femoral Component with Cement. A Five to Eight-Year Follow-up Study. The Journal of Bone & Joint Surgery*. 1996. DOI: 10.2106/00004623-199607000-00002

[78] Porous-Coated Acetabular Components with Screw Fixation. Five to Ten-Year Results. The Journal of Bone & Joint Surgery*. 1996. DOI: 10.2106/00004623-199607000-00001

[79] Comparison of Preoperative Radiographs and Intraoperative Findings of Fixation of Hemispheric Porous-Coated Sockets. The Journal of Bone and Joint Surgery-American Volume. 2001. DOI: 10.2106/00004623-200112000-00015

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b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.