Fixation for the millennium: the hip.

Abstract

In primary total hip arthroplasty, the choice for acetabular component fixation is relatively simple. For most surgeons now in practice, cementing acetabular components is a relatively little practiced skill. That is not to say that good results cannot be achieved routinely and that there is anything wrong with this approach. Cementless fixation of the acetabulum also is reliable. For revisions, cementless fixation has become the standard method for most surgeons. Fixation of the femoral component is more controversial. Contemporary cemented stems employ a wide variety of design features and surface finishes. Cementless fixation has been shown to be effective in many settings. Revision components are largely cementless and extensively coated, although there is good evidence that roughened surface, tapered components can be effective in the revision setting and that stem modularity may allow for greater intraoperative adaptability.