A systematic review 1 including 234 studies (17 RCTs, 61 other comparative studies, 11 other (not direct comparisons), and 145 observational studies) was abstracted in DARE. Cemented prostheses showed good survival rates at 10 - 15 years plus. There was some evidence that all-polyethylene acetabular components are preferable to metal backed designs in terms of longevity. The comparative evidence strongly suggests that thigh pain is a problem associated with non-cemented porous-coated (and other cementless) implants to which cemented designs are not prone. HA-coated models have better early fixation and less migration than cemented models. Wear rates for ceramic hips are less than that for other materials at the articulating surface of the joint. Cost-effectiveness analysis favoured cemented prostheses.
Comment: The quality of evidence is downgraded by heterogeneity of interventions.
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