The long term success rate of cemented sockets in total hip arthroplas
ty has been well documented in patients who are 60 years of age and ol
der and who have had a followup of as many as 16 years, The failures w
ith cemented sockets have been observed in young patients, patients wi
th poor bone stock (rheumatoid and dysplastic hips) with metal backed
components, and in revision surgery with loss of acetabular bone, Rana
wat et al have shown that most mechanical failures of cemented socket
fixation within 10 years of primary operation is attributable to failu
re to achieve a good fixation initially of the cement and bone, Volume
tric wear of the polyethylene of a cemented socket against a 22- or 28
-mm femoral head is compared with the metal backed cemented and noncem
ented cups, The increase in volumetric polyethylene particles with met
al backed cemented sockets and noncemented sockets will induce histioc
ytic response, The mechanism of histiocytic invasion should be similar
for cemented all polyethylene sockets and noncemented sockets, It man
ifests itself in the cemented socket as global radiolucency when the s
ocket is loose and as osteolysis when it is well fixed for noncemented
and cemented sockets, If the number of particles coming out in a nonc
emented and hybrid total hip replacement are greater, osteolysis would
be expected to increase with longer followup, The technique of cement
ed polyethylene sockets requires organization of the surgical team and
hypotensive epidural anesthesia, Under these conditions the procedure
is very reproducible, As far as cost is concerned, the all polyethyle
ne socket is significantly less expensive, It seems that cemented tota
l hip replacement is most suitable and perhaps is the right kind of op
eration for treating osteoarthritis of the hip for patients who are 60
years of age and older because the procedure is reproducible, the qua
lity of arthroplasty is excellent, and it is durable, lasting as many
as 15 years in 90% to 95% of the cases.