Indications and contraindications for using cementless acetabular cups in the elderly?

• A. Indicated with good bone quality and adequate bone stock; contraindicated in poor bone quality or osteoporosis or poor bone stock.
• B. Indicated for all elderly regardless of bone quality.
• C. There are no contraindications.
• D. Contraindicated if patient has good bone stock.

Answer: (B)

The main idea is that cementless acetabular cups rely on the surrounding bone to achieve stable fixation through ingrowth. Because this biologic bonding requires solid bone stock, the elderly patient is not automatically a candidate simply by age; bone quality and acetabular bone stock are the controlling factors.

In practice, a cementless cup is most appropriate when there is good bone quality and adequate bone stock to allow a secure press-fit and subsequent osseointegration. If osteoporosis or poor bone stock is present, initial stability is at risk and long-term fixation may be compromised, making cementless fixation less reliable. In such cases, a cemented cup or a hybrid approach is often favored, sometimes with augments or cages to address bone defects.

So, rather than being universally indicated for all elderly, cementless acetabular cups should be chosen based on bone quality and stock: good bone favors cementless fixation; poor bone quality or bone loss argues against it. The other options don’t fit this nuance, since there are definite contraindications with poor bone quality, and age alone is not the sole determinant.