Purpose: The purpose of this retrospective study was to assess long-term clinical and radiological outcome in a continuous series of alumine-alumine total hip arthroplasties.

Material and methods: This series included 118 total hip arthroplasties performed in 106 patients (70 men and 36 women), mean age 62.2 ± 11.9 years (32–89). Primary degenerative hip disease was the main aetiology. All the arthroplasties were performed by the same operator. In all cases, the femoral piece was a titanium alloy with a Morse cone for fixation of the femoral head; an “all alumine” cup was used for all. The implants were fixed with cement for 85 hips, without cemented for 29, and with a hybrid technique for four. The Merle d’Aubigné score was used to assess clinical outcome. Classical landmarks on the AP pelvis views were used to assess implant migration. Cup wear was measured using the Livermore method. Actuarial survival curves were plotted.

Results: At mean follow-up of 20 years, 45 patients (51 hips) were still living and had not required revision. Twenty-five patients (25 hips) had undergone revision for replacement of the acetabular component and/or the femoral component. Twenty-seven patients (30 hips) had died and nine patients (12 hips) were lost to follow-up. The mean functional score was 16.2 ± 1.8 at last follow-up. Cumulated survival at 20 years was 85.6% (95%CI 72.2–99.0) for cups without cement compared with 61.2% (95%CI 46.8–75.6) for stems without cement (log rank test p = 0.0162). Cumulated survival at 20 years was 84.9% (95%CI 71.1–98.8) for stems without cement compared with 87.3% (95%CI 77.4–97.1) for cemented stems (log rank, p < 0.05). Wear was unmeasurable. Osteolytic lesions required reconstruction with an allograft in three of the 25 revisions. There were no cases with fracture of the alumine head or cup.

Discussion: The limited number of cases with osteolysis at 20 years is probably related to minimal wear of the prosthetic components. Fixation of alumine cups could still be improved.