2008 Otto Aufranc Award: component design and technique affect cement penetration in hip resurfacing

Either excessive or insufficient cement penetration within the femoral head after hip resurfacing influences the risk of femoral failures. However, the factors controlling cement penetration are not yet fully understood. We determined the effect of femoral component design and cementation technique on cement penetration. Six retrieved femoral heads were resurfaced for each implant (BHR, ASR, Conserve Plus, DuROM, ReCAP) using the manufacturers' recommendations for implantation. In addition, the BHR was implanted using the Conserve Plus high-viscosity cementation technique, "BHR/hvt," and vice versa for the Conserve, "Conserve/lvt." The average cement penetration was highest with BHR (65.62% +/- 15.16%) compared with ASR (12.25% +/- 5.12%), Conserve Plus(R) (19.43% +/- 5.28%), DuROM (17.73% +/- 3.96%), and ReCAP (26.09% +/- 5.20%). Cement penetration in BHR/hvt remained higher than all other implants equaling 36.7% +/- 6.6%. Greater femoral component design clearance correlated with cement mantle thickness. Femoral component design in hip resurfacing plays a major role in cement penetration.