Metal-backed acetabular cups in total hip arthroplasty

Metal backing for the acetabular component of a total hip replacement, initially designed to allow replacement of the polyethylene liner, has since been universally accepted as a means of decreasing peak stresses at the interfaces of bone and cement. We studied the results of 238 total hip replacements that had been performed between 1980 and 1983 and that differed only in that 138 of the acetabular components had a metal backing and 100 were made of polyethylene only. Kaplan-Meier survival analysis, with three different modes of failure (radiolucency, loosening, and revision), showed a significant increase in the rate of failure of the metal-backed acetabular cup compared with the all-polyethylene cup: radiolucency, 39 compared with 23 per cent (p less than 0.0001); loosening, 4 compared with 2 per cent (p less than 0.0001); and revision, 6 compared with 2 per cent (p less than 0.0034). It was concluded that metal backing cannot be recommended for a cemented acetabular component of a total hip-replacement system.