The posterior approach reduces the risk of thin cement mantles with a straight femoral stem design.
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.
Macpherson
Gavin J
GJ
Department of Orthopaedic Surgery, University of Edinburgh, The Royal Infirmary of Edinburgh, UK.
Hank
Christian
C
Schneider
Michael
M
Trayner
Morag
M
Elton
Robert
R
Howie
Colin R
CR
Breusch
Steffen J
SJ
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
J Arthroplasty. 1988;3(4):285-97
3071572
J Bone Joint Surg Br. 2008 Jan;90(1):107-13
18160511
J Bone Joint Surg Br. 2000 Aug;82(6):842-5
10990308
J Bone Joint Surg Br. 1990 Nov;72(6):971-9
2246300
J Bone Joint Surg Br. 2006 Dec;88(12):1584-90
17159168
Arch Orthop Trauma Surg. 2001;121(1-2):38-42
11195116
Acta Orthop Scand. 2002 Jan;73(1):54-9
11928912
J Bone Joint Surg Br. 1996 Sep;78(5):802-8
8836075
J Bone Joint Surg Br. 1997 Jul;79(4):603-8
9250746
J Arthroplasty. 1999 Jun;14(4):414-25
10428221
J Bone Joint Surg Am. 1986 Jul;68(6):912-9
3525569
Clin Orthop Relat Res. 1998 Oct;(355):70-6
9917592
J Bone Joint Surg Br. 1998 Jul;80(4):585-90
9699816
J Bone Joint Surg Br. 1990 Sep;72(5):757-60
2211749
Acta Orthop Scand. 1999 Dec;70(6):596-8
10665725
Hip Int. 2007 Oct-Dec;17(4):212-7
19197870
J Arthroplasty. 1997 Jun;12(4):434-43
9195320
J Bone Joint Surg Br. 2001 Aug;83(6):838-42
11521925
J Bone Joint Surg Br. 2006 Sep;88(9):1252-6
16943482
Acta Orthop Scand. 2001 Jun;72(3):228-32
11480595
Clin Orthop Relat Res. 2001 Dec;(393):38-51
11764369
Proc Inst Mech Eng H. 2007 Aug;221(6):585-99
17937198
Med Eng Phys. 2008 Oct;30(8):1042-8
18280197
Clin Orthop Relat Res. 2008 Feb;466(2):324-31
18196413
J Bone Joint Surg Br. 1991 Jul;73(4):551-8
2071634
Acta Orthop Scand. 1981 Oct;52(5):531-42
7331789
J Bone Joint Surg Am. 1997 Mar;79(3):447-52
9070538
J Bone Joint Surg Br. 1992 May;74(3):385-9
1587883
J Bone Joint Surg Am. 1994 Jan;76(1):77-87
8288668
J Bone Joint Surg Br. 2005 Jul;87(7):928-33
15972904
J Arthroplasty. 2001 Aug;16(5):648-57
11503126
Clin Orthop Relat Res. 2006 Jul;448:87-91
16826101
J Arthroplasty. 2005 Oct;20(7):857-65
16230235
Arch Orthop Trauma Surg. 1991;110(4):190-4
1892713
Clin Orthop Relat Res. 2004 Jan;(418):112-8
15043101