Surgical Techniques: Modern Cementing Techniques

Abstract

When Charnley first introduced his concept of low friction arthroplasty of the hip, he advocated fixation of both the femoral and acetabular components with polymethylmethacrylate bone cement (1). While the initial results were good, a higher rate of failure has been seen on the acetabular side when fixation with cement is utilized, and thus the majority of surgeons in North America presently use a cementless acetabular component (2). However, there continues to be considerable controversy surrounding fixation of the femoral component in total hip arthroplasty. Despite advancements in cementless femoral components, cementing the femoral component with polymethylmethacrylate arguably remains the long-term standard for fixation. The performance of a cemented femoral component is dependent upon multiple variables: patient selection, stem size, canal preparation, cement preparation and strength, as well as cementing techniques including achieving a continuous cement mantle. It is clear that the results of total hip arthroplasty performed with a cemented femoral component are related to the quality of the cement mantle. Other factors such as geometry of the stem, its surface finish probably also play a role; however, the best design is still heavy debated. The aim of this chapter is to review the evolution of modern cementing techniques and how the surgical techniques employed effect the durability of total hip arthroplasty performed with a cemented femoral component.