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. 2026 Jan;50(1):101-109.
doi: 10.1007/s00264-025-06687-x. Epub 2025 Nov 4.

Osseointegration of threaded acetabular cups - radiological and histological evaluation after total hip arthroplasty

Elisabeth M Mandler  1 , Peter Lorenz  1 , Stephanie Huber  2 , Jochen G Hofstaetter  3   2 , Lena Hirtler  4 , Gilbert M Schwarz  5   1
Affiliations

Osseointegration of threaded acetabular cups - radiological and histological evaluation after total hip arthroplasty

Elisabeth M Mandler et al. Int Orthop. 2026 Jan.

Abstract

Purpose: Aseptic loosening of the acetabular cup component is the primary cause for complex revision surgery following total hip arthroplasty. However, the extent to which the different zones of the prosthetic contribute to successful osseointegration and how reliable this integration can be assessed using conventional radiographs remain unclear. The aim of the study was to evaluate the osseointegration of cementless threaded acetabular cups through a combination of radiological analysis and histological validation.

Methods: Eight hemipelves of body donors with cementless threaded acetabular cups were included in this study. Conventional radiographs were used to assess the specimens for existing radiolucent lines, periprosthetic osteolysis, or fractures. For histological analysis, thin sections of the acetabular cup were examined for the presence of a periprosthetic membrane, particle debris or inflammatory cells. The areas of visible contact were identified and the bone-to-implant contact (BIC) was calculated.

Results: Radiographic analysis revealed no signs of insufficient osseointegration, osteolytic lesions, or periprosthetic loosening, in any of the specimens. Histological examination showed an average osseointegration rate of 41.84%. Bone-to-implant contact analysis showed no significant differences between different sectors or zones, or between conical and bi-conical acetabular cups.

Conclusion: This study highlights successful osseointegration of cementless threaded acetabular cups, with a mean survival of 18.2 years. Radiological imaging aligned closely to histological finding, confirming implant stability and long-term clinical effectiveness.

Keywords: Cementless threaded acetabular cups; Osseointegration; Total hip arthroplasty.

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Conflict of interest statement

Declarations. Ethics approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Medical University of Vienna (EK. Nr.: 1102/2022). Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
DeLee and Charnley zones I, II, III (Figure created according to Miller [17])
Fig. 2
Fig. 2
Hemipelvis with schematic incision. A) The initial incision was made through the center of the acetabular cup (white line), with two additional parallel incisions at 1 cm intervals, creating a superolateral (a) and inferomedial (b) section. B) Thin sections through the * superolateral (zone 1) and ** inferomedial (zone 3) area of the implant, corresponding to the DeLee and Charnley zones (1976). The implant margin highlighted in green represents zone 1AS, the red-highlighted margin represents zone 3PI and the blue-highlighted margin represents zone 2B
Fig. 3
Fig. 3
Thin section subdivision into zones: zone 1 corresponds to the anterior-superior, zone 2 to the base and zone 3 to the posterior-inferior part of the acetabulum, (a) bi-conical acetabular cup (b) conical acetabular cup. Scale bar signifies 10 mm
Fig. 4
Fig. 4
Example of three base surfaces with ingrown bone (*) and connective tissue (#). Scale bar signifies 10 mm
Fig. 5
Fig. 5
A: Cavity between the base of the prosthesis and the bone. Scale bar signifies 10 mm. B-D: inferioposterior acetabular rim without bone contact in thin sections of three different specimens (marked using red circles)
See this image and copyright information in PMC

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