Background: In total hip arthroplasty, techniques
for cementing the femoral component have changed over time. The
purpose of the present study was to determine whether a cementing
technique that includes use of a distal cement plug and retrograde
filling of the femoral canal affects the fixation of the femoral
component at a minimum of twenty years after the operation.
Methods: Between 1976 and 1978, the senior one of
us (R.C.J.) performed 357 total hip arthroplasties with use of a Charnley
flatback polished femoral stem and a contemporary cementing technique
(insertion of a distal cement plug and retrograde filling of the
femoral canal with cement) in 320 patients. The results after a
minimum follow-up of twenty years were compared with those after 330
total hip arthroplasties performed, between 1970 and 1972, with
the same femoral stem by the same surgeon with use of a hand-packing
technique of cementing in 262 patients. The clinical and radiographic
evaluation as well as the duration of follow-up were identical in
the two groups.
Results: In the group managed with the contemporary
cementing technique, six (1.8%) of the 336 hips that had
not been lost to follow-up or revised because of infection or dislocation
were revised because of aseptic loosening of the femoral component.
Of the ninety-one hips in the eighty-two patients who were alive
at a minimum of twenty years, five (5%) had a revision
because of aseptic loosening of the femoral component. Only one
hip was revised during the fifteen-to-twenty-year follow-up interval.
(The revision was performed because of a fracture of the femoral
component.) The rate of failure when radiographic signs of loosening
were included was 4.8% (sixteen of 336 femoral components
that had not been revised because of infection or dislocation) for
the group managed with the contemporary cementing technique compared
with 6.3% (twenty of 319 hips) in the group managed with
the hand-packing technique; the difference was not significant (p = 0.40).
Adequate filling of the femoral canal with cement was found to be associated
with improved survival of the femoral component (p = 0.03).
Conclusions: While no significant difference between
the two cementing techniques could be identified, the ability to
deliver adequate cement around the femoral component was more predictable
with the contemporary cementing technique. In addition, the prevalence
of loosening of the femoral component was low with use of either
technique, a tribute to the Charnley flatback polished femoral component