The cement mantle in total hip arthroplasty. Analysis of long-term radiographic results

The correlation between the thickness of the cement mantle, the medullary canal fill, and the orientation of the stem and the long-term radiographic outcome of 836 cemented femoral components in patients who had a primary total hip replacement was assessed with use of survival analysis over a twenty-one-year follow-up period. The femoral stems of hips that had a two to five-millimeter-thick cement mantle in the proximal medial region had a better outcome than stems implanted with a thicker or thinner cement mantle. Stems in femora with less than two millimeters of proximal medial cancellous bone had a better outcome than stems in femora with thicker cancellous bone. Stems that filled more than half of the medullary canal had better radiographic results than those that filled half or less. Progressive loosening, fracture of the cement, and radiolucent lines at the stem-cement or bone-cement interfaces were more likely to develop in stems that were oriented in more than 5 degrees of varus than in those in neutral or valgus. The noted correlations were true whether the stem was made of titanium alloy or of stainless steel. The results of this study emphasize the importance of careful preoperative planning in total hip arthroplasty done with cement and provide guidelines for the selection of the shape, size, and position of the stem.