SURGICAL PEARLS: When to Cement the Stem in Primary THA
Daniel J. Berry, MD, readily admits that he uses uncemented triple-taper stems in 95% of the primary total hip arthroplasty (THA) procedures he performs. And he’s not alone: In a poll conducted at the 2020 annual meeting of the American Association of Hip & Knee Surgeons, 93% of respondents said they use uncemented stems in more than 75% of their primary THAs. 
Uncemented stems are easy to use, with the best designs providing, in Dr. Berry’s words, “superb results.”
However, there are times when a cemented stem is the better choice, he told attendees at the 9th Annual ICJR South Hip & Knee Course. Research and registry data show that in select patients, cemented stems outperform uncemented stems, sometimes by a wide margin. Notably higher failure rates are seen when uncemented stems are used in older patients undergoing elective THA and patients undergoing THA for a hip fracture, Dr. Berry said.
The 2 causes of higher failure rates are early periprosthetic fracture and early loosening. Cementing the stem avoids these issues, as long as the cementing is done well technically.
Dr. Berry said that surgeons who still don’t want to use a cemented stem in these situations can avoid the postoperative fractures and loosening that may occur with uncemented stems by:
- Double-checking for calcar fractures intraoperatively
- Adding prophylactic cables even if no fracture is evident
- Using stems with more fixation surface, such as ream and broach-style stems or double- or triple-taper stems
- Avoiding blade-shaped stems
Click the image above to watch Dr. Berry’s presentation and learn more about cementing femoral stems in primary THA.
Daniel J. Berry, MD, is the LZ Gund Professor of Orthopaedics at Mayo Clinic, Rochester, Minnesota.
Disclosures: Dr. Berry has disclosed that he receives royalties from DePuy Synthes.
- Abdel MP, Meneghini RM, Berry DJ. Current practice trends in primary hip and knee arthroplasties among members of the American Association of Hip and Knee Surgeons: an update during the covid-19 pandemic. J Arthroplasty. 2021 Jul;36(7S):S40-S44.e3. doi: 10.1016/j.arth.2021.01.080. Epub 2021 Feb 11.