Fixation of the cemented acetabular component in hip arthroplasty

Research output: ThesisDoctoral Thesis (compilation)


In total hip arthroplasty cemented fixation of the acetabular component is a generally successful concept, but the rate of aseptic loosening and consequent revision surgery is still too high. One of the crucial factors for longterm implant survival is the initial fixation and stability. This thesis comprises experimental and clinical studies, including radiostereometry (RSA) with up to 5 years follow-up, all investigating the requirements for improved cement fixation of the acetabular component. The results and conclusions of the studies are:

Higher cementation pressure than normally can be achieved is needed for desirable cement penetration, especially as there is obstructing blood circulation in the recipient bone bed.

There is no difference between cancellous bone from the acetabulum and from load-bearing areas of the

femoral head regarding permeability and structural parameters. Results from studies made on bone from the

more obtainable femoral heads can thus be extrapolated to the acetabulum.

Sequential pressurization of individual anchorage holes before filling the rest of acetabulum with cement is one method of reaching higher pressure and better cement penetration than is achievable with fingerpacking or conventional pressurization. This technique does not impair the cement strength, provided it is performed within

4 minutes of cement mixing and the cement area is kept free from blood or washed with saline.

Pressure applied during the early phase of cementation has the greatest effect on cement penetration.

However, the highest pressure is attained later during cup insertion, but does not further increase the penetration.

Improved cement penetration in the anchorage holes has a stabilizing effect on cup inclination over time.

Early radiolucency, even as a thin demarcation line, is a strong predictor of later cup migration as measured by RSA.

Preparation of the acetabular bone bed is an important factor for cup fixation. Contrary to earlier theories,

removal of the subchondral bone plate, where possible, appears advantageous. It results in a radiographically

superior cement-bone interface, and RSA indicates similar or even better cup stability as compared to retention

of the subchondral bone plate.

Correct preparation of the bone bed in combination with adequate cement pressurization and cup insertion

according to the principles delineated in this thesis should result in better long-term survival in hip arthroplasty.


Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Orthopedics


  • traumatology, Kirurgi, ortopedi, traumatologi, orthopaedics, reumatologi, Surgery, Skelett, muscle system, rheumatology locomotion, Skeleton, Cement pressurization, Cement penetration, Acetabulum, Cancellous bone, muskelsystem, Total hip arthroplasty, RSA
Original languageEnglish
Awarding Institution
Supervisors/Assistant supervisor
  • Leif Ryd, Supervisor
  • Tanner, Liz, Supervisor, External person
Award date2005 Mar 11
  • Department of Orthopaedics, Lund University
Print ISBNs91-85439-07-X
Publication statusPublished - 2005
Publication categoryResearch

Bibliographic note

Defence details Date: 2005-03-11 Time: 09:00 Place: Lund University Hospital Föreläsningssal 1 External reviewer(s) Name: Søballe, Kjeld Title: Professor Affiliation: University Hospital Arhus, Denmark ---