Abstract
Background:The line-to-line cementing technique is proposed to create a press-fit in the femoral canal, which is contrary to modern cementing techniques. The term ‘French paradox’ has been used to describe the acceptable results associated with this technique. It has been suggested that the quality of the mantle may not be satisfactory, predisposing to early failure and aseptic loosening.Methods:The line-to-line cementing technique, where the femoral stem was oversized by 1 size compared to the broach, was compared to the standard cementing technique using corresponding sized broaches and stems, in 6 pairs of human cadaver femora with taper-slip design C-stems. Cement pressure was measured, and cement mantle thickness was analysed. A mixed effects model with random intercepts was used to examine the relationship between thickness of mantle and cementing technique and between pressure and cementing technique.Results:Line-to-line cementing results in significantly higher pressurisation for longer periods of time leading to better interdigitation but a thinner mantle in some areas.Conclusions:The results of this study describe the in-vitro advantages and disadvantages of the line-to-line cementing technique.
Highlights
Total hip arthroplasty (THA) is 1 of the most successful procedures in orthopaedic surgery with relatively low complication rates and a high degree of patient satisfaction.[1,2] Very thin cement mantle thickness and defects in its substance have been correlated to possible early failure and aseptic loosening.[3,4] The purpose of the line-to-line cementing technique is to achieve an optimal micro interlock between cement and bone and to create a fitting composite mantle envelope.[5]
This surgical technique stands in prominent contradiction to the philosophy of current cementing technique resulting in a cement mantle thickness of 2–4 mm by using an smaller stem than broach.[6,7]
Several studies have investigated the line-to-line versus the standard cementing technique, but there appears to be a need to explore the relationship between cement pressure and cement mantle thickness in the 2 cementing philosophies
Summary
Total hip arthroplasty (THA) is 1 of the most successful procedures in orthopaedic surgery with relatively low complication rates and a high degree of patient satisfaction.[1,2] Very thin cement mantle thickness and defects in its substance have been correlated to possible early failure and aseptic loosening.[3,4] The purpose of the line-to-line cementing technique (line-to-line) is to achieve an optimal micro interlock between cement and bone and to create a fitting composite mantle envelope.[5]. Several studies have investigated the line-to-line versus the standard cementing technique (standard), but there appears to be a need to explore the relationship between cement pressure and cement mantle thickness in the 2 cementing philosophies. The aim of the study was to measure the differences in cement pressure and cement mantle thickness by comparing the line-to-line and the standard cementing of the femoral stem in hip arthroplasty. The line-to-line cementing technique is proposed to create a press-fit in the femoral canal, which is contrary to modern cementing techniques. A mixed effects model with random intercepts was used to examine the relationship between thickness of mantle and cementing technique and between pressure and cementing technique. Conclusions: The results of this study describe the in-vitro advantages and disadvantages of the line-to-line cementing technique
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