Influence of cement technique on upon cement penetration in femoral cancellous bone

The purpose of this study was to determine the influence of jet-lavage and cement pressurising techniques upon cement penetration into proximal femora l cancellous bone. In a cadaver study 60 left human cadaver femora were use d for implantation of cemented stem components. Four different groups of ce menting techniques were generated, the allocation to the groups was randomi sed. Bone lavage was carried out either using jet-lavage or manual syringe lavage, cement application differed with regard to the amount of pressurisa tion used. Five different stem designs were used. Radiographs were taken an d horizontal sections were obtained at predefined levels (2 cm) using a dia mond saw. Microradiographs were taken and analysed using image analysis to assess cement penetration into cancellous bone. In an additional study the influence of jet-lavage (1000 ml) Versus syringe lavage (1000 ml) was studi ed in 11 paired human cadaver femora. The specimens were imbedded in specia lly designed pots. Bone cement was applied in a retrograde manner and subje cted to a standard pressure protocol with a constant force of 3000 N. The a nalysis protocol was identical to the main experiment. Both jet-ravage and pressurisation of bone cement significantly improved the penetration of cem ent into cancellous bone (p = 0,027 and p = 0,003, respectively). In the pr esence of strong, dense cancellous bone the findings were more pronounced. In the additional comparative study cement intrusion was significantly bett er (p < 0,001) in the jet-lavage group. We did not observe an influence of the stem type upon outcome (penetration). The use of jet-lavage yields sign ificantly improved cement penetration and should be regarded mandatory in c emented total hip arthroplasty. High pressurising techniques are effective means to improve the interdigitation between cancellous bone and cement, bu t should only be administered in combination with jet-lavage to reduce the risk of thrombo-embolic complications.