Cemented femoral fixation: the North Atlantic divide

In the United Kingdom, more cemented than cementless stems are implanted, whereas in North America, few cemented stems are implanted. This is primarily because cemented stems have not performed well in North America, whereas they have in the United Kingdom, as different designs have been used. The majority of cemented stems used in the United Kingdom are polished, collarless, and tapered. These are forgiving, as they subside within the cement mantle and compress the cement and stabilize the interface. They perform well in both young and active patients and elderly patients. They also do well in osteoporotic bone, with deformity, or with suboptimal cementing techniques. As the position of the stem can be varied, it is simple to achieve appropriate leg length, offset, and version. Cement can be used to deliver antibiotics locally. If revision is necessary, it is relatively straightforward. Cement has numerous advantages that outweigh the main disadvantage of an extended operating time.