Femoral Stem Cementation in Hip Arthroplasty: The Know-How of a “Lost” Art

Revisiting Cemented Femoral Fixation in Hip Arthroplasty

“…More severe BCIS has been associated with increasing patient age, particularly patients who are >75 years old and those with an American Society of Anesthesiologists (ASA) physical status classification of ≥3, renal impairment, chronic obstructive pulmonary disease, cancer and lung metastases, and use of diuretics or warfarin 43,46,49 . Identifying patients with severe systemic disease prior to surgery is essential and should involve a thorough medical evaluation to address comorbidities to the extent possible 43,48,50,51 . Severe BCIS, although rare, can be fatal.…”

Femoral Stem Cementation in Primary Total Hip Arthroplasty

“…Modern canal preparation begins with broaching, which has demonstrated superiority over reaming in cadaveric models, with increased interface failure load 81 . Repetitive irrigation and suctioning should be performed between broaching to mitigate the risk of embolism 8,50 .…”

“…However, this consensus was not without controversy because some studies reported that vacuum mixing did not decrease overall porosity in cemented stems, contrary to other studies and the general accepted belief [51][52][53] . Despite these contradictory studies, there is sufficient evidence to warrant vacuum mixing for cementing femoral stems, and it is considered a standard part of contemporary cementation 8,50 .…”

“…Several studies have noted that thorough high-pressure pulse lavage promotes cement interdigitation, distribution, and implant stability 82-84 . By removing potentially intervening blood, fat, and marrow cells, it also reduces embolization risk and bone cement implantation syndrome 8 . As such, thorough pulse lavage became a standard procedure in clinical practice and is recommended in the American Academy of Orthopaedic Surgeons Toolkit 85 .…”

“…This growing preference is probably explained by good outcomes of cementless fixation, shorter operative times, and the added technical complexity of cementation. As such, the scientific and clinical details of cementing femoral components are becoming more esoteric and are at risk of becoming lost on new trainees 8 . More importantly, there is a growing body of evidence indicating advantages of cemented femoral fixation, especially in poor bone stock, highlighting the importance of a solid understanding of femoral stem cementation for the orthopaedic surgeon’s repertoire.…”