This document discusses modern cementing techniques for femoral components in total hip replacements. It emphasizes the importance of micro-interlock between the bone and cement for long-term results. Key steps in the technique include pulsatile lavage of the femoral canal, use of a cement restrictor, cooled vacuum mixed cement, applying a proximal seal and pressurizing for 2-4 minutes, and allowing sufficient time for cement to harden before stem insertion. Contemporary cementing techniques with these features are associated with significantly lower revision rates based on long-term registry data analysis.

2. Successful cementing depends on “micro-interlock”!

6. ?? – the C 2 problem

9. posterior

13. Pulsatile lavage is the most important feature in modern cementing technique Repeat until clear fluid in return!!

15. first peak of fat embolisation with insertion of cement restrictor

17. Insert the cement restrictor with press fit! Monitor the position! Think of the poor guy doing the revision 10 years later!!

21. Do not cut the nozzle before filling Do not throw it away

23. Seal the femur canal and pressurize 2-4 minutes

30. Increased pressurization time - increased micro interlock?

32. Timing of stem insertion - polished versus textured?

34. Cement mantle quality is essential for long-term results Apply the routine – every time! reproducible results !

35. ” white-out phenomena"

40. ?

42. An option to update your cementing technique 2005

43. Thank You! Orthopaedic Biomechanics and Biomaterials Laboratory Massachusetts General Hospital