When is cement used for total hip replacement?

Controversy exists regarding when cement should be used in total hip replacement surgery. One of the main disadvantages of cemented total hip replacement is that although the components are solid the day they are implanted, they begin a gradual process of loosening every day thereafter. Although this is usually not a problem in patients with life expectancies less than 15-20 years, younger, heavier, or more active patients will develop loosening and require revision surgery even earlier. Therefore, cementless fixation is felt by most surgeons to be best for young, heavy, or active patients.

Cement can have harmful effects. When cement is injected into the femur, it forces fat, various proteins including enzymes and clotting factors, and other debris into the circulation where it is filtered out by the lungs. This can result in difficulty breathing, blood clots, and rarely even death. Many surgeons (including myself) choose to use cementless fixation in all patients to avoid the harmful effects of cement.

Some surgeons believe that cement is necessary to secure the femoral component to the femur in certain patients, particularly in older patients with softer bone. However, use of a femoral component design known as a “tapered” design allows implantation in almost all patients without the use of cement, thereby avoiding its potentially harmful effects. Additionally, tapered stems allow immediate full weight bearing on the hip, unlike many other cementless designs. Therefore, tapered, cementless femoral components can be used in essentially all patients without delay in weight bearing or recovery.

Read Dr. Swanson’s Publications and Presentations on Stem Design.

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