The condition of the Cement Mantle in Femoral Hip Prosthesis Implantations – a Post Mortem Retrieval Study

Despite numerous studies demonstrating the characteristics of the optimal cement mantle in joint replacement, the clinical state of the cement mantle is rarely assessed. A random sample of 214 cemented implated femoral hip components was retrieved post mortem from Hamburg, Germany, and sectioned to investigate the quality of the cement mantle. The most common observation made in at least one measured region per retrieval was debonding (82% of stems), followed by a thin cement mantle (74%), stem-bone contact (48%), soft tissue at the stem interface (44%), no cement-bone interdigitation (30%), a gap at the stem interface (28%), voids in the cement (22%) and cracks and blood in the cement mantle (<10%). 21% of stems demonstrated complete debonding of the interface. However, distributions of all other defects were local, with less than 10% of stems demonstrating any imperfection in more than 21% of the regions assessed. No progressive damage was observed with implantation duration. The results suggest that current implantation technique may be adequate for proper implant function over the service life in the older patient population. However, for younger and more active patients, perfection of the cementation technique is crucial, particularly in modern implant systems such as resurfacing. The frequency of almost all defects could be further reduced by careful implantation technique, providing the increased service life necessary for the ever younger, more physically demanding, patient population.