The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Tantalum Versus Titanium Acetabular Cups in Primary Total Hip Arthroplasty: Current Concept and a Review of the Current Literature

Document Type : CURRENT CONCEPTS REVIEW

Authors
Rohit Rambani 1
Mayur Nayak 1
Miss Sheweidin Aziz 2
Krishan Almeida 2
1 Department of Orthopaedics, Pilgrim Hospital, Boston, United Lincolnshire NHS trust, Lincolnshire, UK
2 University Hospitals Leicester NHS Trusts, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW
10.22038/abjs.2021.55255.2750
Abstract
Background: Primary total hip arthroplasty (THA) is becoming an increasingly popular and efficacious medical procedure. 
There have been a number of studies evaluating tantalum acetabular cups compared with the conventional titanium 
acetabular cups for use in total hip arthroplasties. We conducted a systematic review and summarize clinical studies 
comparing tantalum acetabular cups with the conventional titanium acetabular cups for use in primary total hip arthroplasties.
Methods: A literature search was performed to find all relevant clinical studies until March 2020, which then underwent 
a further selection criteria. The inclusion criteria was set as follows: Reporting on human patients undergoing primary 
total hip arthroplasty; Direct comparison between tantalum acetabular cups with conventional titanium acetabular cups 
for use in primary total hip arthroplasty; Radiological evaluation (cup migration, osteointegration); Clinical (functional 
scores, need for subsequent revision, patient-reported outcomes; Post-operative complications; Reporting findings in 
the English Language. After a thorough search a total of six studies were included in the review. The primary outcome 
measures were clinical outcomes, implant migration, change in bone mineral density and rate of revision and infection. 
Results: Tantalum is superior to titanium with regards to fewer radiolucencies, 100% survivorship at 12 years postoperatively, improved long-term implant osteointegration and survivorship as well as decreasing osteolysis and 
mechanical loosening. There has been no significant difference in radioisometric analysis, bone mineral density or 
Harris Hip Score. Revision and infection rates were found to be significantly lower in tantalum group at 10 years from 
pooled data of national joint registry (England and Wales), while it was found to be higher in the same at 9 years from 
pooled data of Swedish and Australian registry although this is not statistically significant.
Conclusion: The use of tantalum should be reserved for cases of high risk of failure or mechanical loosening, where 
failure of a contralateral joint occurred. The use of Tantalum carries lower risk of failure and infection. Further studies 
with longer follow-up would be useful in drawing further conclusions. 
Level of evidence: II
Keywords
Acetabular cup
Primary total hip arthroplasty
Tantalum
Titanium
  1. Liang MH, Cullen KE, Larson MG, Thompson MS, Schwartz JA, Fossel AH, et al. Cost-effectiveness of total joint arthroplasty in osteoarthritis. Arthritis Rheum. 1986 Aug;29(8):937–43.
  2. Jonsson B, Larsson SE. Functional improvement and costs of hip and knee arthroplasty in destructive rheumatoid arthritis. Scand J Rheumatol. 1991;20(5):351–7.
  3. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007 Apr;89(4):780–5.
  4. Della Valle CJ, Mesko NW, Quigley L, Rosenberg AG, Jacobs JJ, Galante JO. Primary total hip arthroplasty with a porous-coated acetabular component. A concise follow-up, at a minimum of twenty years, of previous reports. J Bone Joint Surg Am. 2009 May;91(5):1130–5.
  5. Engh CA, Hopper RH, Engh CA. Long-term porous-coated cup survivorship using spikes, screws, and press-fitting for initial fixation. J Arthroplasty. 2004 Oct;19(7 Suppl 2):54–60.
  6. Udomkiat P, Dorr LD, Wan Z. Cementless hemispheric porous-coated sockets implanted with press-fit technique without screws: average ten-year follow-up. J Bone Joint Surg Am. 2002 Jul;84(7):1195–200.
  7. Eskelinen A, Remes V, Helenius I, Pulkkinen P, Nevalainen J, Paavolainen P. Uncemented total hip arthroplasty for primary osteoarthritis in young patients: a mid-to long-term follow-up study from the Finnish Arthroplasty Register. Acta Orthop. 2006 Feb;77(1):57–70.
  8. Utting MR, Raghuvanshi M, Amirfeyz R, Blom AW, Learmonth ID, Bannister GC. The Harris-Galante porous-coated, hemispherical, polyethylene-lined acetabular component in patients under 50 years of age: a 12- to 16-year review. J Bone Joint Surg Br. 2008 Nov;90(11):1422–7.
  9. Bobyn JD, Toh KK, Hacking SA, Tanzer M, Krygier JJ. Tissue response to porous tantalum acetabular cups: a canine model. J Arthroplasty. 1999 Apr;14(3):347–54.
  10. Bobyn JD, Stackpool GJ, Hacking SA, Tanzer M, Krygier JJ. Characteristics of bone ingrowth and interface mechanics of a new porous tantalum biomaterial. J Bone Joint Surg Br. 1999 Sep;81(5):907–14.
  11. Nakashima Y, Mashima N, Imai H, Mitsugi N, Taki N, Mochida Y, et al. Clinical and radiographic evaluation of total hip arthroplasties using porous tantalum modular acetabular components: 5-year follow-up of clinical trial. Mod Rheumatol. 2013 Jan;23(1):112–8.
  12. Komarasamy B, Vadivelu R, Bruce A, Kershaw C, Davison J. Clinical and radiological outcome following total hip arthroplasty with an uncemented trabecular metal monoblock acetabular cup. Acta Orthop Belg. 2006 Jun;72(3):320–5.
  13. Mulier M, Rys B, Moke L. Hedrocel trabecular metal monoblock acetabular cups: mid-term results. Acta Orthop Belg. 2006 Jun;72(3):326–31.
  14. Macheras G, Kateros K, Kostakos A, Koutsostathis S, Danomaras D, Papagelopoulos PJ. Eight- to ten-year clinical and radiographic outcome of a porous tantalum monoblock acetabular component. J Arthroplasty. 2009 Aug;24(5):705–9.
  15. Banerjee S, Issa K, Kapadia BH, Pivec R, Khanuja HS, Mont MA. Systematic review on outcomes of acetabular revisions with highly-porous metals. Int Orthop. 2014 Apr;38(4):689–702.
  16. Bobyn JD, Poggie RA, Krygier JJ, Lewallen DG, Hanssen AD, Lewis RJ, et al. Clinical validation of a structural porous tantalum biomaterial for adult reconstruction. J Bone Joint Surg Am. 2004;86-A Suppl 2:123–9.
  17. Kamada T, Mashima N, Nakashima Y, Imai H, Takeba J, Miura H. Mid-term clinical and radiographic outcomes of porous tantalum modular acetabular components for hip dysplasia. J Arthroplasty. 2015 Apr;30(4):607–10.
  18. Harris WH, White RE. Socket fixation using a metal-backed acetabular component for total hip replacement. A minimum five-year follow-up. J Bone Joint Surg Am. 1982 Jun;64(5):745–8.
  19. Harris WH, Penenberg BL. Further follow-up on socket fixation using a metal-backed acetabular component for total hip replacement. A minimum ten-year follow-up study. J Bone Joint Surg Am. 1987 Oct;69(8):1140–3.
  20. Shirazi-Adl A, Dammak M, Paiement G. Experimental determination of friction characteristics at the trabecular bone/porous-coated metal interface in cementless implants. J Biomed Mater Res. 1993 Feb;27(2):167–75.
  21. Wegrzyn J, Kaufman KR, Hanssen AD, Lewallen DG. Performance of Porous Tantalum vs. Titanium Cup in Total Hip Arthroplasty: Randomized Trial with Minimum 10-Year Follow-Up. J Arthroplasty. 2015 Jun;30(6):1008–13.
  22. Baad-Hansen T, Kold S, Nielsen PT, Laursen MB, Christensen PH, Soballe K. Comparison of trabecular metal cups and titanium fiber-mesh cups in primary hip arthroplasty: a randomized RSA and bone mineral densitometry study of 50 hips. Acta Orthop. 2011 Apr;82(2):155–60.
  23. Ayers DC, Greene M, Snyder B, Aubin M, Drew J, Bragdon C. Radiostereometric analysis study of tantalum compared with titanium acetabular cups and highly cross-linked compared with conventional liners in young patients undergoing total hip replacement. J Bone Joint Surg Am. 2015 Apr 15;97(8):627–34.
  24. Meneghini RM, Ford KS, McCollough CH, Hanssen AD, Lewallen DG. Bone remodeling around porous metal cementless acetabular components. J Arthroplasty. 2010 Aug;25(5):741–7.
  25. Laaksonen I, Lorimer M, Gromov K, Eskelinen A, Rolfson O, Graves SE, et al. Trabecular metal acetabular components in primary total hip arthroplasty. Acta Orthop. 2018 Jun;89(3):259–64.
  26. Matharu GS, Judge A, Pandit HG, Murray DW. Which factors influence the rate of failure following metal-on-metal hip arthroplasty revision surgery performed for adverse reactions to metal debris? an analysis from the National Joint Registry for England and Wales. Bone Jt J. 2017 Aug;99-B(8):1020–7.
  27. Poggie RA, Brown TD, Pedersen DR. Finite elements analysis of peri-acetabular stress of cemented, metal-backed, and porous tantalum backed acetabular components. Trans Orthop Res Soc. 1999; 24:747
  28. Wilkinson JM, Peel NF, Elson RA, Stockley I, Eastell R. Measuring bone mineral density of the pelvis and proximal femur after total hip arthroplasty. J Bone Joint Surg Br. 2001 Mar;83(2):283–8.
  29. Tokarski AT, Novack TA, Parvizi J. Is tantalum protective against infection in revision total hip arthroplasty? Bone Jt J. 2015 Jan;97-B(1):45–9.
The Archives of Bone and Joint Surgery
Volume 10, Issue 5
May 2022
Pages 385-394

  • Receive Date 28 January 2021
  • Revise Date 13 June 2021
  • Accept Date 24 July 2021