title: The posterior approach reduces the risk of thin cement mantles with a straight femoral stem design.
abstract: OBJECTIVE
  The properties of the cement mantle around a prosthesis are important. We investigated whether the surgical approach to the hip influences the quality and thickness of the cement mantle when using a straight femoral stem design.
  
  
  METHODS
  In a consecutive multi-surgeon series, we reviewed the radiographs of 270 patients after cemented Exeter total hip arthroplasty. 135 stems were introduced using an antero-lateral (transgluteal) approach and 135 stems were introduced using a posterior approach. Anterior-posterior and lateral radiographs were reviewed and cement mantle thickness was measured in Gruen zones 1-14. We graded cement mantle quality according to the Barrack classification.
  
  
  RESULTS
  Barrack grading did not reveal any difference in cement mantle quality between the two groups. AP and lateral radiographs showed no difference in stem alignment between the groups. The risk of a thin cement mantle (< 2 mm) was lower with a posterior approach (OR = 1.8, 95% CI: 1-3; p = 0.03). The greatest risk of a cement mantle thickness of < 2 mm occurred in Gruen zones 8-9 regardless of the surgical approach used.
  
  
  CONCLUSIONS
  With a straight femoral stem design, the posterior approach to the hip joint appears to give a lower risk of a thin cement mantle. Irrespective of the approach, there was a risk of thin cement mantles in Gruen zones 8 and 9, which highlights the importance of lateral radiographs in the postoperative radiographic assessment of total hip replacements.
authors.affiliation: Department of Orthopaedic Surgery, University of Edinburgh, The Royal Infirmary of Edinburgh, UK.
authors.forename: Gavin J
authors.initials: GJ
authors.lastname: Macpherson
authors.forename: Christian
authors.initials: C
authors.lastname: Hank
authors.forename: Michael
authors.initials: M
authors.lastname: Schneider
authors.forename: Morag
authors.initials: M
authors.lastname: Trayner
authors.forename: Robert
authors.initials: R
authors.lastname: Elton
authors.forename: Colin R
authors.initials: CR
authors.lastname: Howie
authors.forename: Steffen J
authors.initials: SJ
authors.lastname: Breusch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods; D002484:Cementation; D005260:Female; D006621:Hip Joint / Q000000981:diagnostic imaging; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D012307:Risk Factors
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