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Should the cement mantle around the femoral component be thick or thin?

Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK.

S. Todo, MD, Orthopaedic Surgeon

Department of Orthopaedic Surgery, Osaka City University Medical School, Abeno-Ku, Asahinachi, 1-4-3 Osaka 545-8585, Japan.

M. Taylor, PhD, Lecturer

Department of Biomedical Engineering, University of Southampton, University Road, Highfield Road, Southampton SO17 1BJ, UK.

J. S. Wang, PhD, Lecturer

Biomaterials Laboratory, C12, BMC, Department of Orthopaedics, Lund University, S22184 Lund, Sweden.

V. Pinskerova, MD, Orthopaedic Surgeon

Charles University, Prague, Czech Republic.

G. Scott, FRCS, Consultant Orthopaedic Surgeon

The Royal London Hospital, Whitechapel Road, London E1 4DG, UK.

Correspondence should be sent to Mr J. A. Skinner.

We have compared the survival and radiological outcome at ten years after total hip replacement using two techniques for preparing the femoral canal. The same prosthesis was used throughout and all operations were performed by the same surgical team. In technique 1 the canal was over-reamed by 2 mm and in technique 2 it was reamed to the same size as the prosthesis. Technique 1 was performed on 92 patients and technique 2 on 97 patients.

The survival at ten years was 97.2% (90.6 to 99.2) for technique 1 and 98.8% (92.9 to 99.8) for technique 2. Vertical migration was greater in technique 1 (1.8 mm versus 1.0 mm at five years; p = 0.36). There were significantly more lytic lesions and radiolucent lines at five years (p = 0.0061) with technique 1. We conclude that technique 2 is not worse and may produce better long- term results than current teaching suggests.

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