Fixation Strategies in Total Hip Arthroplasty.

Substantial progress has been achieved in cementless arthroplasty in the recent decades where cementless arthroplasty has evolved from pressfit implantation to porous-coated and later HA-coated implant fixation as its ultimate current state-of-the-art incarnation. Key factors for success are adequate primary stability of the device in the bone supported by design and surface structure variables that together with optimal implant biocompatibility result in durable osseo-integration of the device. Excellent survival rates past 20 years are documented in both literature and registries with quantitative studies confirming the excellent implant stability and bone quality. Elderly, younger, or medically compromised patients may require specific attention to avoid problems, but in general, every patient can be given the benefit of modern cementless hip arthroplasty. With an optimal consideration for patient-related factors as well as anatomic reconstruction of the arthroplasty, modern cementless arthroplasty provides every patient an outlook on both excellent long-term functionality and survival.