ArticleActa orthopaedica2026
Early acetabular cup migration is associated with long-term aseptic loosening: investigation of 1-year and 2-year radiostereometric analysis cohort migration thresholds against acetabular cup survivorship from two national registries.
Article in Acta orthopaedica, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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9 authors.
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Abstract
background and purpose2-year proximal migration thresholds for acetabular cups used at primary total hip arthroplasty were first established in 2012 by matching radiostereometric analysis (RSA) measurements of cup migration with long-term survivorship from cohort studies. Subsequently, there have been new RSA studies reporting migration of contemporary cup designs whose survivorships are available from long-term registry data. The primary aim of this study was to re-evaluate the 2-year postoperative RSA migration thresholds and investigate whether thresholds at time points earlier than 2 years were possible.
methodsThe mean 6-month, 1-, and 2-year proximal migration of each RSA cohort was matched to the pooled 10-year proportion of acetabular cup revision due to aseptic loosening in the Australian Orthopaedic Association National Joint Replacement Registry and the Dutch Arthroplasty Registry in 2023. Revision rates were pooled according to these classifications using a random effects model.
results164 implant-survival combinations (228,053 cups), involving 27 cup designs, were identified with RSA migration data to 2 years. At 1 year, mean cup migration of ≤ 0.1 mm was considered acceptable, while migration > 0.8 mm was unacceptable. The pooled proportions of acetabular cup revision in the acceptable, at-risk, and unacceptable threshold categories were 0.36% (95% confidence interval [CI] 0.26-0.47), 1.05% (CI 0.80-1.31), and 5.07% (CI 1.41-8.73) respectively. At 2 years, mean cup migration ≤ 0.2 mm was considered acceptable while mean migration > 1.0 mm had unacceptable survivorship. The pooled proportions of acetabular cup revision in the acceptable, at-risk, and unacceptable threshold categories were 0.55% (CI 0.48-0.62), 1.27% (CI 0.87-1.67), and 21.6% (CI 0.0-54.7), respectively, meaning that acetabular cups with high migration can be identified at both 1 and 2 years.
conclusionThis study confirmed the existing 2-year migration thresholds and established a new threshold at 1 year. We found no association between continuous migration between 1 and 2 years and 10-year revision rates. The 1-year migration threshold is the earliest surrogate measure for assessing late loosening of the acetabular cup and may identify underperforming implants.
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