Abstract
In North America, cementless femoral replacement has all but replaced cementing and cement technique is at risk for becoming a lost art. Published results of cemented femoral components with a well-designed femoral component and good surgical technique are excellent and equivalent to cementless technology. With an increasing focus on cost as part of value-based care, consideration for returning to cement for a select population is appropriate. Furthermore, there are patient populations that may benefit from a cemented femur with registries demonstrating superior short term outcomes. These include the elderly and patients with osteoporotic femurs.
The goal of femoral cementing is to maximise the interdigitation of bone cement with metaphyseal trabecular bone and the irregular surface of the endosteum while at the same time minimizing the risk of embolization.
The steps for femoral cementing include:cFemoral broaching – understand the relationship between the broach and stem as it relates to cement mantle thickness; Canal preparation; Gentle curetting to remove loose cancellous bone; Pressurised lavage to remove fat and marrow elements – this decreases the risk of embolization and enhances the strength of the bone-cement interface; Dry the canal – suction, adrenaline soaked sponge – this minimises bleeding and enhances the strength of the bone cement interface; Cement preparation – vacuum mix or centrifuge the bone cement – this minimise large voids that weaken the bone cement; Cement insertion – insert in a retrograde fashion and pressurise the cement – this optimises the cement column and the bone cement interface; Stem insertion – insert slowly with a system that centralises the stem – this prevents mantle defects that have been associated with stem loosening.
