Sealing the acetabular notch in cemented total hip arthroplasty. A radiological review of 380 cases

Recent in vitro work has shown that sealing the acetabular notch with bone graft in bovine acetabulum samples results in improved cement penetration in the acetabular bone during total hip arthroplasty. Successful sealing of the notch may be identified on postoperative films by a lack of cement extrusion. This study aimed to assess the clinical effectiveness of this technique in preventing cement escape and early radiolucent lines by review of early postoperative radiographs. We reviewed the post-operative radiographs of 380 consecutive patients who underwent primary total hip arthroplasty with implantation of the same flanged cemented polyethylene cup. The incidence, site and extent of cement extrusion and the incidence of any early postoperative radiolucent lines at the cement bone interface were measured. We found the rate of inferior cement escape in our series was 9.2%, compared to 36.4% in a previous study. We also found a lower rate of early radiolucent lines compared to historical controls. We believe placing bone graft on the medial/inferior wall prior to cementing helps to increase cement pressurisation by sealing the acetabular notch, as identified by reduced cement escape and early radiolucent lines.