We undertook a review of the literature relating to the two basic stem designs in use in cemented hip replacement, namely loaded tapers or force-closed femoral stems, and the composite beam or shape-closed designs. The associated stem fixation theory as understood from in vitro studies and finite element modelling were examined with reference to the survivorship results for each of the concepts of fixation. It is clear that both design principles are capable of producing successful long-term results, providing that their specific requirements of stem metallurgy, shape and
A modular femoral head–neck junction has practical
advantages in total hip replacement. Taper fretting and corrosion
have so far been an infrequent cause of revision. The role of design
and manufacturing variables continues to be debated. Over the past
decade several changes in technology and clinical practice might
result in an increase in clinically significant taper fretting and
corrosion. Those factors include an increased usage of large diameter
(36 mm) heads, reduced femoral neck and taper dimensions, greater
variability in taper assembly with smaller incision surgery, and
higher taper stresses due to increased patient weight and/or physical
activity. Additional studies are needed to determine the role of
taper assembly compared with design, manufacturing and other implant
variables. Cite this article:
Polymethylmethacrylate remains one of the most enduring materials in orthopaedic surgery. It has a central role in the success of total joint replacement and is also used in newer techniques such as percutaneous vertebroplasty and kyphoplasty. This article describes the current uses and limitations of polymethylmethacrylate in orthopaedic surgery. It focuses on its mechanical and chemical properties and links these to its clinical performance. The behaviour of antibiotic-loaded bone cement are discussed, together with areas of research that are now shedding light upon the behaviour of this unique biomaterial.
