Thanks to the remarkable and continuous improvements in surgical techniques, in biomaterials and in implant design, total hip arthroplasty has reached excellent results. Based on our experience, we use several products to face the daily difficulties in the operating room. Unfortunately the “perfect” prosthesis does not exist yet, so it is necessary to evaluate and balance advantages and disadvantages to get the best results for the patients. There are many ongoing studies on new biomaterials; a great number of these are focused on reproducing the morphology of real bone: Trabecular Titanium^TM is one of these. Its bone-like elastic modulus and high compression resistance makes it suitable for joint replacements. Trabecular Titanium^TM has been integrated in the Delta-TT acetabular system creating cups with a trabecular surface that favours bone ingrowth and guarantees an adequate osteointegration and an effective primary stability. We appreciated Trabecular Titanium^TM from the beginning; in fact we observed its positive results in revision surgeries, and also in major cases of acetabular defects where a strong primary fixation was fundamental. Then we decided to use Trabecular Titanium^TM also in first implants in patients with coxarthrosis (primary or secondary), with dysplasia, with trauma and osteonecrosis. 36 patients (mean age 77) have been treated with DELTA-TT acetabular cups from June 2008 to December 2010. The initial diagnosis were: 25 patients with primary coxarthrosis, 6 patients with hip dysplasia, 3 patients with avascular necrosis and 2 patients with post traumatic head necrosis. We found that especially in the cases of secondary coxarthrosis, despite of a correct pre-operative planning, it was frequent to find extremely poor bone conditions due to degenerative changes of both bony and soft tissue implying bone defects. In such cases it is fundamental to have a system that guarantees the management of every type of difficulty. For example, considering the cases in which primary stability is not enough, the DELTA-TT system offers the possibility of inserting up-to three screws. 

This was necessary only in two cases of severe hip dysplasia and in one case of post traumatic head necrosis. In the other surgeries of our series the rough surface of the cup offered an excellent primary fixation. Moreover, the opportunity to use different liners made of ceramic, metal or UHMWPE gives surgeons the chance of selecting the best bearing for every situation, restoring the physiologic hip biomechanics, with the additional option of the protruding components. In our 36 cases, patients reached good functional results and no radiographic loosening signs were found after a maximum follow up of 30 months. Our experience with Trabecular Titanium^TM showed satisfying short-term results but, obviously, a longer follow up is required to have a definitive confirmation.