Cementing Technique in Total Hip Replacement: Factors Influencing Survival of Femoral Components

Abstract

This article gives an overview of the current status of modern cementing techniques for femoral component anchorage. The rationale of cemented hip arthroplasty and factors influencing long-term outcome are discussed. The aim during cement application is to establish a durable interface between cement and cancellous bone and furthermore an even, non-deficient cement mantle. A minimum cement mantle thickness of 2–3 mm is regarded essential to minimize the risk of osteolysis and loosening. Cement mantle thickness depends on femoral anatomy, stem size and design and centralizer usage. The radiographic results from a cadaver study suggest that critical zones of cement mantle thickness exist in Gruen zones 8/9 and 12, which can only be assessed on lateral radiographs. Cement penetration is improved by the use of a distal femoral plug, cement pressurizing techniques and pulsatile lavage, which have all been shown to reduce the risk of aseptic loosening. The influence of bone preparation, lavage technique and mode of cement application were investigated and the results are presented. Our findings indicate that syringe-lavage is significantly less effective with regard to cleansing capacity of cancellous bone as measured by cement penetration. Although pressurized application of cement is beneficial to improve cement interdigitation, thromboembolic complications may result as a consequence of raised intramedullary pressure. A new animal model is presented that confirms the efficacy of pulsatile lavage in reducing the bulk of medullary content. The use of pulsatile lavage (jet-lavage) is considered of paramount importance to achieve excellent cement penetration and to reduce the risk of fat embolism. Its use should be considered mandatory in cemented total hip arthroplasty.