The results of improved cementing techniques for total hip arthroplasty in patients less than fifty years old. A ten-year follow-up study.

Thirty-six patients (forty-two hips) in whom so-called second-generation cementing techniques, such as medullary lavage, use of an intramedullary cement plug, hand-mixing of the cement, and use of a cement gun to deliver the cement in a doughy state in a retrograde fashion, had been used for a primary total hip arthroplasty were evaluated at an average of eleven years (range, ten to fifteen years) after the operation. All of the patients had been less than fifty years old at the time of the operation. Thirty-one patients were evaluated by clinical and radiographic examinations and five, by a telephone interview. Twelve components (ten acetabular components [24 per cent] and two femoral components [5 per cent]) in ten hips had been revised for aseptic loosening. An additional five acetabular components (12 per cent) and five femoral components were definitely loose according to radiographic criteria. Three of these femoral components were polished stems that were considered loose only because of the presence of a radiolucent line, 0.5, one, and two millimeters wide, at the prosthesis-cement interface in zone 1 of Gruen et al. The other two loose stems were in patients who were receiving renal dialysis. These findings demonstrate excellent fixation of the femoral component but continued problems with fixation of the acetabular component despite the use of improved cementing techniques.