Hydroxyapatite-coated acetabular cup were used in revision hip arthroplasty without using bone grafts or bone substitutes to achieve osseointegration in 30 consecutive hips (29 patients). The mean age was 72.5 years (range 54 to 88). Primary prosthesis was 14 Charnley’s, 12 Capital 3M, one Furlong, one Exeter and one MacKee Farrar. Indication for revision was aseptic loosening in 20, recurrent dislocation in four, periprosthetic fracture in two, prosthesis fracture in one, and three infected hips.

Patients were assessed clinically using Harris Hip Score, satisfaction questionnaire and quality of life SF 36 questionnaire, and radiologically using DeLee and Charnley, Harris-Barrack, and Hodgkinson’s Engh’s classification, and Bassetlaw Digital Scoring System (BDSS) that we have devised. The acetabular defects were assessed preoperatively using the American Academy of Orthopaedic Surgeons (AAOS) classification.

Mean follow up was 38.7 months (range 18.5–76.4). Ninety present of acetabular cups had preoperative radiolucency in all DeLee and Charnley’s zones. 26 hips (87%) had no superior or lateral cup migration. Two hips had 3 mm superior migration at one year then remained stable. Mean improvement of Harris hip score was 42.2. 83.3% of hips had no or slight pain at final follow up.

Five patients had dislocations one of which was recurrent that required acetabular cup revision. Two patients had postoperative foot drop that recovered fully. Two patients had postoperative wound infection that healed with antibiotics apart from one who died due to multi-organ failure. Four patients died due to unrelated causes.

Postoperative radiographs showed stable fixation of all acetabular cups. 83.3% of hips had no or slight pain at final follow up.

Early results show that stable fixation in revision hip surgery can be obtained with HAC acetabular cups without bone grafts or bony substitute.