Second-generation metal-on-metal bearings have been used since the late 1980s as alternative bearings to eliminate aseptic loosening due to polyethylene wear.

The aim of the present study was to evaluate the long-term results of a series of Metasul (Zimmer GmbH, Winterthur, Switzerland) metal-on-metal total hip arthroplasty (THA). Between January 1993 and September 1996, 149 cementless THAs with a 28 mm Metasul articulation were performed in 111 consecutive patients. Implant survivorship was calculated and clinical and radiographic evaluations were performed on 82 hips still available for follow-up at a mean of 18 years postoperatively.

Nine hips (6.0%) were revised. The cumulative probability of survival of the overall implant at 18 years postoperatively with revision for any reason as the end point, was 0.937 (95% confidence interval, 0.888 to 0.985). The cumulative probability of survival of Metasul with revision for any reason as the end point, was 0.956 (95% confidence interval, 0.916 to 0.997). Various degrees of radiolucencies and osteolysis were found proximally around the femoral components of 25 hips (20%).

Cementless Metasul THA showed high survival at 18 years postoperatively.