Abstract
A cemented stem is certainly a good technique to choose for patients 75 years of age or older. In Europe, cemented stems remain prevalent for all ages. In my experience a patient with a cemented stem is comfortable sooner and the leg is also stronger sooner. Cement technique is the most important factor of a cemented stem and with good technique these stems have shown 30 years of longevity in published follow up studies.
Technical points: 1.) Broach only. No reaming. 2.) Maintain hard cancellous bone in the metaphysis. Do not keep weak, loose bone. Brush loose bone away. 3.) Irrigate the femur until the irrigant is clear. Pack it with absorbent gauze (we use Kerlix). 4.) Place a plug and insert cement with a gun and manually pressurise the cement until you feel strong back pressure. 5.) The stem should be press-fit into the cement to force interdigitation of cement into the bone. This means the cement cannot be liquid when the stem is inserted. It must be doughy. 6.) The cement mantle should be 2–3mm circumferentially so pick the correct stem size to permit that. A centraliser will help centralise the tip of the stem in the cement column and prevent the stem being against the edge of the bone which breaks the cement column.
