![]() ![]() The introduction of the low-friction cemented polyethylene hip prosthesis by Professor John Charnley in 1962 marked a true revolution for hip surgery. An extensive literature search could not identify a single systematic review comparing the results of cemented or cementless fixation of the acetabulum in the indication of primary osteoarthritis alone. Although the cementless cup, popular in western Europe and the United States, achieves better results each year, cementing the acetabulum remains, according to some, the gold standard to which any other Total Hip Prosthesis (THP) should be compared. To this day, however, controversy remains on whether or not to cement the acetabular cup. ![]() Total hip arthroplasty in the treatment of debilitating primary osteoarthritis of the hip has evolved to a very safe and cost-effective intervention with revision rates of less than 5% after 10 years. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Irrespective of age, cemented fixation of the acetabulum remains the gold standard to which other techniques should be compared. Discussion: The widespread preference for cementless fixation of the acetabulum cannot be explained by a superior survival of cementless or hybrid models. While cemented prostheses were the cheapest option, hybrids were the most cost-effective. Cemented prostheses had a similar or lower risk of revision compared to hybrid prostheses in every study, but performed slightly worse on functionality and quality of life. All studies concerning the risk of revision were based on registry data, covering a total of 365,693 cups. Results: A total of 1032 studies were identified whereof twelve were included for qualitative synthesis. Studies comparing the clinical (revision rate, functionality), radiological (wear) or economic (cost) differences between cemented (cemented stem with cemented cup) and hybrid (cemented stem with uncemented cup) prostheses for primary osteoarthritis of the hip were identified as eligible. Methods: A comprehensive PubMed search of the English literature for studies published between 20 was performed. * Corresponding author: Total Hip Arthroplasty (THA) in the treatment of primary osteoarthritis of the hip has evolved to a very safe and cost-effective intervention with revision rates below 5% after 10 years. ![]() Master of Medicine, KU Leuven, BergsMoorsel, BelgiumÄepartment of Development and Regeneration, KU Leuven, HerestrLeuven, Belgium ![]()
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