1. Sr Consultant & Joint Replacement Surgeon
THE CEMENTED CUP
Dr. Vivek Mittal
Sr Consultant & Joint Replacement Surgeon
DITO, New Delhi, India.

2. 6 decades ‘Gold Standard’
When we talk of cemented hip, we all remember Sir John Charnley. We salute him for giving us a successful implant and wonderful technique to implant it
6 decades
‘Gold Standard’

3. Cemented THR Results Minimum 10y F/up Study # F/u Rev (no’s) (yrs) (%)
Fowler
Ranawat
Rieter
These were the results 20 yrs back, but are good by any standard

4. Cemented THR Results 18 – 20 yrs F/up Study # F/u Rev
(no’s) (yrs) (%)
Wroblewski
Shulte
& these results after 20 yrs implantation, excellent, but remember 2 factors: all of these guys are masters in craftsmanship, & Charnley 1 had better results

5. Cemented Sockets - Younger Pts
10 yr survival
Ballard, Johnston -78%
JBJS 1994
Cornell, Ranawat %
JBJS 1986
Sullivan, Johnston -90%
Sedel %
However in young & active individuals the revision rates were unacceptable from 10 to 22%

6. Survivorship of Cemented vs Uncemented Cup
Age Group
10 yrs
15 yrs
20 yrs 90 77 69 95 81 - 87 97 91 96 98
> 75
Finnish Registry Data JBJS 2008

7. Current Trends: Region Based
Swedish Hip Registry 2008
Australian Jt Registry 2009

8. CEMENT = Polymer + Monomer (powder) (liquid) Catalyst
Only a grouting agent – No adhesive property / Reduces high stress concentration
Strong in Compression
Weak in tension / shear
Factors affecting Cement
Bone Stock – Adequate
Cementing Technique – Appropriate
Dry surface
Pressurization of cement
Uniform cement mantle of 2-3mm
What is cement?

9. CEMENT = Polymer + Monomer (powder) (liquid) Catalyst
Factors affecting Cement
Bone Stock – Adequate
Environment : Room Temp / Moisture
Mixing Technique
Additives
What is cement?
Clinically altered
Mixing time
Working time
Setting time

10. Appro. Cement Technique
Aim: To achieve highly durable Macro / micro interlock into cortico – cancellous bone
Cement – Bone Interface
Preserve - Cancellous Bone
Maximize Area – Multiple Drill Holes
Dry & Clean Bone – Pulse Lavage + Hypotensive Anesthesia
Cementing Technique
Cement
Insert - before blood contamination
Low viscosity & pressurize (1.5mts)
Prosthesis - insert slowly &
Maintain pressure until cement cured

12. Radiographic Classification
Type 1
Homogenous
No radiolucency
Type 2
Incomplete
Type 3
Complete radiolucency in > 1 zone
Type 1
Homogenous
No radiolucency
Type 1
Homogenous
No radiolucency
Type 2
Incomplete

13. Conclusion
Team dependant rather Individual dependent (Surgeon / Associates / Nurse / Anesthetist)
Difficult to achieve consistency in cementing
Technique is Crucial
Bloodless Field
Pressurization of cement
2-3 mm uniform cement mantle
33f 1987
52f 2008