An in vitro study of femoral intramedullary pressures during hip replacement using modern cement technique

Five femora (four cadaveric and one plastic) were used to measure the intramedullary pressures simultaneously at two different locations along the proximal femur during the insertion of bone cement and the femoral component using modern cement technique. The pressures were monitored by transducers located at the midpoint of each femoral stem (P1), and just beyond the tip of the femoral stem proximal to a cement plug (P2). Transient increases in intramedullary pressure were noted during the initial compaction of the bone cement using a conventional device. However, during insertion of the femoral component, the pressures at P1 and P2 increased dramatically to peak pressures exceeding 2385 mm Hg at P1 and 3710 mm Hg at P2 respectively. These pressure elevations were not sustained; eight to 10 minutes after prosthesis insertion, the pressures decreased to below baseline levels in all five femora. This probably resulted from contraction of the cement during the curing phase. Transient elevations of intramedullary pressure to levels greater than 100 times capillary pressure are produced during hip replacement using modern cement technique. The highest pressures are generated during insertion of the femoral component rather than during the cement compaction step. These findings suggest that the use of a cement compactor to improve intrusion of the cement into bone is probably unnecessary.