Direct Anterior Total Hip Arthroplasty Using the Muller Line-To-Line Cement Technique: A Propensity Score Matched...

Area of Science:

• Orthopedic Surgery
• Arthroplasty Research
• Biomaterials Engineering

Background:

• Cemented fixation is regaining interest in primary total hip arthroplasty (THA), particularly with the direct anterior (DA) approach.
• Integrating cementation with the DA approach presents challenges, especially in patients with complex femoral anatomies.

Purpose of the Study:

• To evaluate the feasibility and radiographic outcomes of the Müller line-to-line cementation technique in primary cemented DA-THA.
• To compare these outcomes against a propensity score-matched (PSM) cohort undergoing cementless press-fit DA-THA.

Main Methods:

• Retrospective analysis of 202 patients (101 cemented, 101 cementless) undergoing primary DA-THA (2016-2018).
• Cemented group used a polished stainless-steel stem; press-fit group used a tapered-wedge titanium alloy stem.
• Radiographic outcomes assessed: stem malposition, radiolucency, cement mantle integrity, canal fit-and-fill, and implant stability at 1.7-year mean follow-up.

Main Results:

• No stem malposition, subsidence, or cement mantle compromise in the cemented DA-THA group.
• 10.8% of cemented cases showed femoral cortical thinning (physiological aging).
• 5.9% of cementless DA-THA patients experienced periprosthetic fractures or subsidence requiring revision.

Conclusions:

• The Müller line-to-line cementation technique in primary DA-THA yields excellent radiographic outcomes.
• This technique enhances operative efficiency and adaptability in challenging femoral morphologies.
• Ongoing long-term data collection will further validate these findings.