A radiographic study of the detection limits of bone-cement remnants in total joint arthroplasty

Management of an infected hip prosthesis typically requires that all associated cement be removed. In the absence of gross mantle loosening, the surgeon frequently resorts to intraoperative radiographs to assess the completeness of removal. For this reason, we undertook a study to determine limits of detection of retained cement by routine radiography. Polymethyl methacrylate bone-cement beads (Simplex-P; Stryker-Howmedica-Osteonics, Allendale, NJ) were fashioned into graduated sizes and placed within cadaver medullary canals using 2 different methods. Standard radiographic images were obtained. Individually and independently, we viewed these images and proposed the limit of resolution to be 2.4 to 3.2 mm. It is difficult to remove all cement based on radiographs alone. These results suggest a need to use techniques that permit visualization of the canal to ensure adequate cement removal.