Cemented Total Hip Replacement

Cemented total hip arthroplasty was first used in the late 1950s. The great pioneers were McKee and Farrar and John Charnley in England. The McKee operation fell into disrepute because the relatively primitive metal on metal technology gave rise to an unsatisfactory early failure rate (this has now been corrected by modern sophisticated metal materials, designs, and tribology). Cemented classical total hip replacements are still the “gold standard” to this very day:
the leading prostheses giving the best long term results according to the Scandinavian Arthroplasty Registries are the Charnley, the Exeter, the Stanmore, and the Lubinus. Using these long established cemented prostheses the patient can expect good function after 20 years in 80% of the cases.

These methods use a metal head on a metal stem both made of stainless steel or chrome cobalt. The head moves in a plastic high density polyethylene cup. Both the cup and the stem are anchored to the bone by the bone cement which is made of polymethylmethacrilate often impregnated with antibiotics to prevent infection.

Nowadays many surgeons use a ceramic head instead of the metal head since this may cause lessening of the wear of the plastic cup. The main disadvantage of these classical arthroplasties is that inevitably there is wear of the plastic cup and the microscopic wear particles cause an inflammation which brings about loosening of the prosthetic parts by dissolving the bone around the cement mantle:
loosening causes pain and loss of function and often a second revision operation is required.
Recently new highly cross linked polyethylenes have been advocated for the cups owing to their superior wear properties in laboratory tests:
however nothing is known about their long-term behavior inside the body tissues.
Nevertheless cemented classical total hip replacement gives excellent results for many years and is still the operation of choice in elderly active and geriatric patients.

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