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Fixation of the acetabular component. The case for cement
C S Ranawat1, L E Peters, M E Umlas
1Center for Total Joint Replacement, Lenox Hill Hospital, New York, NY 10021, USA.
Clinical Orthopaedics and Related Research
|December 31, 1997
Summary
Cemented total hip replacement is a durable, reproducible, and cost-effective option for patients over 60. This procedure demonstrates excellent arthroplasty quality and long-term success rates, making it suitable for osteoarthritis treatment.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Arthroplasty Research
Background:
- Long-term success of cemented sockets in total hip arthroplasty (THA) is established in older patients (>60 years) with up to 16-year follow-up.
- Failures in cemented sockets are noted in younger patients, those with poor bone stock (rheumatoid, dysplastic hips), and in revision surgeries with acetabular bone loss.
- Mechanical failures of cemented socket fixation within 10 years are often linked to initial poor cement-bone fixation.
Purpose of the Study:
- To compare volumetric wear of polyethylene in cemented sockets with metal-backed cemented and non-cemented cups.
- To investigate the histiocytic response to polyethylene particles generated from different socket types.
- To evaluate the suitability of cemented THA for osteoarthritis in patients aged 60 and older.
Main Methods:
- Comparison of volumetric wear rates between all-polyethylene cemented sockets and metal-backed cemented/non-cemented cups using 22- or 28-mm femoral heads.
- Analysis of histiocytic response to polyethylene particles, noting similarities between cemented and non-cemented sockets.
- Assessment of the reproducibility and cost-effectiveness of the cemented polyethylene socket technique.
Main Results:
- Increased volumetric polyethylene particles from metal-backed cemented and non-cemented sockets induce a histiocytic response.
- Histiocytic invasion manifests as global radiolucency (loose) or osteolysis (well-fixed) in cemented and non-cemented sockets.
- Osteolysis is expected to increase with longer follow-up in non-cemented and hybrid THA due to higher particle generation.
Conclusions:
- Cemented total hip replacement is highly suitable for osteoarthritis in patients aged 60 and older due to its reproducibility, excellent arthroplasty quality, and durability (90-95% success up to 15 years).
- The all-polyethylene cemented socket is significantly less expensive than alternatives.
- Proper surgical technique, including team organization and hypotensive epidural anesthesia, ensures procedure reproducibility.