Foreword: Advanced Cemented Hip Stems: An Evolution of Our Understanding

Cemented total hip replacement (THR) provides the best long-term results in the literature. Cement was wrongfully indicted as the cause of osteolysis in the early 1980s (cement disease). The subsequent shift to cementless hip arthroplasty resulted in the art of cementation being lost to generations of orthopedic trainees. However, cemented THR remains a highly successful and cost-effective surgical treatment for end-stage arthritis of the hip.

Over the past two decades, stem design has been refined to exploit the favorable material properties of cement. This has led to a marked increase in the usage of highly polished tapered stems, in which subsidence of the stem within the cement mantle engages the taper and optimizes load transfer to the surrounding cement and adjacent bone. The bone cement and the interfaces must be addressed when considering the prosthesis cement bone composite.

Although the composition of cement has been modified to allow customization of the handling properties for specific applications, the basic chemicals in cement have not changed over the past decades. However, the way surgeons use cement has changed. Contemporary cementation techniques involve optimization of the bone cement interlock by appropriate preparation of the bone bed and enhanced pressurization of the cement. The importance of reducing cement porosity and creating a complete cement mantle of adequate thickness has been recognized.

This supplement reviews the evolution of cemented THR and presents current concepts relating to the science and technical execution of cemented hip arthroplasty.

Authors

From *the Department of Orthopedic Surgery, University of Iowa College of Medicine, Iowa City, and †the University of Bristol, Department of Orthopaedic Surgery, Bristol Royal Infirmary, Bristol, United Kingdom.