Uncemented Hemispherical Cups

Uncemented Hemispherical Cups

Joshua S. Bingham

Robert T. Trousdale

Key Concepts

  • Several options are available for acetabular reconstruction in the revision setting, including cementless hemispherical components, impaction grafting, reconstruction cages or rings, hemispherical cups with augments, cemented all-polyethylene components, and custom implants.

  • Although multiple options are available, the great majority of acetabular reconstructions can be successfully performed using an uncemented hemispherical component with screw supplemental augmentation.

  • This surgical technique is straightforward and should be familiar to most arthroplasty surgeons. The mid- and long-term results have been good.

  • Excellent long-term results have been reported with uncemented hemispherical cups in the revision setting (Table 25.1).

  • Highly porous metal implants with enhanced frictional coefficient against bone and high bone-ingrowth potential have expanded the indications for this form of reconstruction.

  • Alternative forms of acetabular reconstruction should be considered in cases with severe segmental bone loss, in cases with a pelvic discontinuity, and in situations in which obtaining bone ingrowth is challenging.

Sterile Instruments and Implants

  • Routine hip retractors.

  • Hand-guided curved acetabular osteotomes for implant removal if required.

  • A curved osteotome explant system for implant removal if needed.

  • Broken screw removal set if screws are present in previous reconstruction.

  • Power burr with pencil tip and carbide attachments.

  • Sequential hemispherical reamers.

  • Cancellous particulate allograft.


  • Either a fully porous coated hemispherical multihole revision acetabular component (with instrumentation) or a highly porous titanium or tantalum cup. For complex revisions consider using a tantalum cup that allows the surgeon to bore supplement screw holes.

  • Appropriately sized acetabular screws with a tap and instrumentation.

  • Full array of bearing options including highly cross-linked polyethylene inserts of different inside diameters with different lateralized or elevated rim options. When instability is a concern, modular dual-mobility implants may be considered.

Table 25.1 ▪ Results of Cementless Acetabular Reconstruction in Revision Total Hip Arthroplasty

Author (y)

No. of Hips

Follow-up in Years (Range)


Della Valle et al. (2005)


17 (15-19)

2.2% of aseptic loosening, 96% survivorship at 15 y

Templeton et al. (2001)


12.9 (11.5-14.3)

3.5% were radiographically loose at last follow-up

Paprosky et al. (1994)


5.7 (3-9)

4.1% rate of failure, all failures in 3B acetabulums

Jamali et al. (2004)


11 (5-17)

5% rate of aseptic loosening

Hallstrom et al. (2004)


12 (10-17)

11% aseptic loosening, 96% survivorship at 12 y

Leopold et al. (1999)


10.5 (7-14)

1.8% radiographically loose at last follow-up

Silverton et al. (1996)


8.3 (7-11)

0.7% failure rate at last follow-up


  • The patient is placed in a lateral decubitus position, which allows for a more extensile exposure if needed.

  • Draping should allow for adequate access to the proximal pelvis and entire femur.

Surgical Approaches

Dec 14, 2019 | Posted by in ORTHOPEDIC | Comments Off on Uncemented Hemispherical Cups

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