Femoral Cementing Techniques: Current Trends in the UK

Abstract

INTRODUCTION The results of a survey conducted amongst hip surgeons in Great Britain on the use of bone cement and femoral cementing techniques are reported.MATERIALS AND METHODS A postal questionnaire was sent out to the members of the British Orthopaedic Association for their opinion on cement usage and femoral cementing techniques in primary hip arthroplasty. RESULTS A majority of surgeons use high viscosity cement (82%) and cement containing antibiotics (77%). Almost a fifth of the respondents were unaware of the place of storage of the cement and of the ambient theatre temperature. Over two-thirds experienced inconsistencies in the handling of cement and attributed this to inconsistent theatre temperature (40%) and storage temperature (14%). A majority of the surgeons followed the 'modern' femoral cementing technique of vacuum mixing (94%), plugging the femoral canal (98%), pulsed lavage (87%), retrograde cement introduction (95%), use of stem centralisers (62%) and cement pressurisation. Four-fifths of the surgeons used time as a guide for cement and stem insertion rather than consistency of the cement.CONCLUSIONS Though most of the surgeons follow contemporary cementing techniques, it appears that inconsistency of the working properties of the cement is a major impediment. Many surgeons are also unaware of the variables that can influence polymerisation and working time of the cement.

Mortality and implant revision rates of hip arthroplasty in patients with osteoarthritis: registry based cohort study

“…Although polymethylmethacrylate (PMMA) bone cement is biocompatible, adverse cardiopulmonary effects 57 58 59 60 61 62 have been widely documented during and after the cementation period. Modern cement techniques, 63 including pressurisation, which were developed to improve cement penetration and fixation can exacerbate these events. 64 During the reaming and pressurisation processes fat, marrow, air, particles of bone, cement, and aggregates of platelets and fibrin are driven into the systemic circulation 57 with the potential for intraoperative and postoperative embolic events and adult respiratory distress syndrome.…”

Bone cement usage modalities at a multi-site university hospital centre

“…The introduction on the market of cementless prostheses, notably for the hip, does not encourage further training about cementation and may explain the limited experience of surgeons with cement preparation, preparation of bone recipient sites, and cement application techniques. Several surveys about cementing practices were performed over the last few decades in other countries [7][8][9], but no detailed information on cementing techniques used in French hospitals is available.…”

Femoral Stem Cementation in Primary Total Hip Arthroplasty

“…Interestingly, a prospective randomized trial by Carlson et al analyzed 226 patients followed for 5 years and demonstrated that cement viscosity had no measurable effect on implant loosening 34 . However, the perception of poor results from low-viscosity cements led to favoring of higher-viscosity cements such that by 2006, 82% of surgeons in the United Kingdom were using high-viscosity cement 15,35 . Regardless, a sizeable minority of surgeons continued to favor low-viscosity and medium-viscosity cements, arguing for a superior penetration into the trabecular bone and stem-cement bonding enhancement 15,36,37 .…”