International Orthopaedics

, Volume 43, Issue 12, pp 2697–2705 | Cite as

The Ganz acetabular reinforcement ring shows excellent long-term results when used as a primary implant: a retrospective analysis of two hundred and forty primary total hip arthroplasties with a minimum follow-up of twenty years

  • Marc C. Attinger
  • Pascal C. Haefeli
  • Henrik C. Bäcker
  • Remy Flueckiger
  • Peter M. Ballmer
  • Klaus A. Siebenrock
  • Frank M. KlenkeEmail author
Original Paper



The acetabular reinforcement ring with a hook (ARRH) has been designed for acetabular total hip arthroplasty (THA) revision. Additionally, the ARRH offers several advantages when used as a primary implant especially in cases with altered acetabular morphology. The implant facilitates anatomic positioning by placing the hook around the teardrop and provides a homogenous base for cementing the polyethylene cup. Therefore, the implant has been widely used in primary total hip arthroplasty at our institution. The present study reports the long-term outcome of the ARRH after a minimum follow-up of 20 years.


Two hundred and ten patients with 240 primary THAs performed between April 1987 and December 1991 using the ARRH were retrospectively reviewed after a minimum follow-up of 20 years. Twenty-three of 240 hips were lost to follow-up, 110 patients with 124 THAs had deceased without having a revision surgery performed. This left 93 hips for final evaluation. Of those, 75 hips were assessed clinically and radiographically after a mean follow-up of 23.1 years (range 21.1–26.1 years). In 18 cases, clinical and radiographic assessment was omitted because implant revision had been performed prior to the follow-up investigation. The primary endpoint was defined as revision for aseptic loosening.


Out of the 93 hips available for final evaluation, 14 hips were revised for aseptic loosening; another four were revised for other reasons (deep infection n = 2, recurrent dislocation n = 2). The survival probability of the cup was 0.96 (95% confidence interval 0.93–0.99) after 20 years with aseptic loosening as endpoint. Radiographic analysis of the surviving 75 hips showed at least one sign of radiographic loosening in 24 hips. The mean Merle d’Aubigne score increased from 8 points pre-operatively to 15 points at final follow-up (7.5 ± 1.8 vs 15.0 ± 2.3, p < 0.001). The mean HHS was 85 ± 14 at final follow-up. Radiographic loosening did not correlate with the clinical outcome.


The long-term results of the ARRH in primary THA are comparable to results with standard cemented cups and modern cementless cups. We believe that the ARRH is a versatile implant for primary THA, especially in cases with limited acetabular coverage and altered acetabular bone stock where the ARRH provides sufficient structural support for a cemented cup.


Ganz ring Acetabular reinforcement ring THA Aseptic loosening Revision 


Compliance with ethical standards

The ethical committee of the canton of Bern, Switzerland approved the study (Ref.-No. KEK-BE: 265/2014).

Conflict of interest statement

The authors declare that they have no conflicts of interest.


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Copyright information

© SICOT aisbl 2019

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery, InselspitalBern University HospitalBernSwitzerland
  2. 2.Department of Orthopaedic Surgery, Spital STS AGHospital ThunThunSwitzerland

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