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Current state of cement fixation in THR
1Laboratory of Orthopaedic Biomechanics-LOB, Orthopaedic Department, University of Basel, Felix Platter-Spital, CH-4012 Basel/Switzerland.
Acta Orthopaedica Belgica
|March 28, 2002
Summary
This review highlights total hip arthroplasty (THA) implant fixation, focusing on cemented stems and cementless sockets. Optimal results depend on surgical technique, cement type, and implant design, not just new prostheses.
Area of Science:
- Orthopedic surgery
- Biomaterials engineering
- Medical device development
Background:
- Total hip arthroplasty (THA) has evolved significantly, with varying approaches to implant fixation.
- Historically, cemented fixation faced challenges, particularly for femoral stems, while cementless sockets achieved early success.
- The choice between cemented and cementless fixation has varied geographically and fluctuated over time.
Purpose of the Study:
- To survey key developments in THA implant fixation, emphasizing acrylic cement.
- To discuss the author's preference for hybrid prostheses (cemented stem, cementless socket) in older patients.
- To analyze factors influencing the success of cemented stems and address historical criticisms.
Main Methods:
- Historical review of total hip arthroplasty implant development.
- Analysis of factors affecting cemented stem fixation, including stem geometry, surface finish, centralizers, and cement type.
- Discussion of surgical technique's impact on outcomes.
Main Results:
- Cementless sockets have a long history of success; cementless femoral stems have also shown excellent long-term results after initial difficulties.
- Cemented implants are experiencing renewed popularity due to factors like cost-effectiveness.
- Optimal fixation of cemented stems requires specific conditions, including appropriate cement choice and surgical technique, which are not always met.
Conclusions:
- Proper analysis suggests that cemented titanium alloy stems have been unfairly discredited.
- The choice of cement and meticulous surgical technique are critical for successful cemented fixation.
- Future THA advancements will likely stem from refining existing systems and optimizing surgical techniques, rather than solely from novel implant designs.