ArticleInternational orthopaedics2026
Trabecular metal cups versus reconstruction cages for primary total hip arthroplasty in the irradiated acetabulum: a nine year comparative cohort study.
Article in International orthopaedics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeAcetabular reconstruction for primary total hip arthroplasty (THA) after pelvic radiotherapy is difficult because irradiated bone integrates poorly, and the optimal fixation method remains undefined, with comparative data lacking. We compared trabecular metal (TM) cups with reconstruction cages for implant survivorship and function.
methodsWe retrospectively reviewed all 40 patients (40 hips) who underwent primary THA after pelvic radiotherapy at a single centre during 2008-2019 (20 TM cups, 20 reconstruction cages) in this unmatched cohort. Groups were compared with unpaired tests; survivorship was estimated by Kaplan-Meier (log-rank), with Firth penalized Cox regression and sensitivity analyses. The primary outcome was survivorship free from aseptic loosening; secondary outcomes were all-cause revision, complications and the Harris Hip Score (HHS).
resultsThe groups were similar in age, sex and radiation dose; follow-up was longer in the cage group (median 9.7 versus 8.4 years; p = 0.036). Ten-year survivorship free from aseptic loosening was 100% (TM) versus 88.2% (cage) (95% CI 59.9%-97.0%; p = 0.182; Firth hazard ratio 3.42, 95% CI 0.52-22.45); all-cause revision-free survivorship was 100% versus 78.5% (95% CI 51.8%-91.4%; p = 0.040; hazard ratio 5.18, 95% CI 0.82-32.74); four of 20 cage hips were revised. Postoperative HHS was higher for TM cups (88.9 versus 81.8, p < 0.001), below the minimal clinically important difference. Complications occurred in 10% versus 25% (p = 0.407).
conclusionIn this small, retrospective cohort, TM cups showed numerically higher survivorship and function than reconstruction cages, but only the revision comparison was significant; the study is underpowered elsewhere. These hypothesis-generating findings require confirmation in larger, multicentre cohorts.
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