Wagner M, Schonthaler H, Endstrasser F, et al. - The present study was carried out to explore a metal-backed liner implant system for primary total hip arthroplasty (THA). Researchers enrolled a total of 422 patients (with 468 consecutive THAs), who were followed over a mean period of ten years. They examined surgical and clinical data, complications, and revisions. They compared Western Ontario and McMaster Universities Osteoarthritis Index before surgery and at one year and at ten years after surgery. This study’s findings demonstrate that THA applying cementless stem, press-fit cup, and metal-backed liner system provides satisfactory long-term outcomes, with revision rate comparable to that with other systems available in the market. The results suggest that a metal-backed liner system has a low risk of mal-seating. It has been considered that third-generation ceramic liners should be avoided as they appear to be more prone to breakage.