The Cemented All-Polyethylene Acetabular Component

CHAPTER OUTLINE
- Indications and Contraindications 137
- Preoperative Planning 138
- Technique 138
- Perioperative and Postoperative Management 140
- Complications 140
- Summary 141

KEY POINTS

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This component is the most common fixation choice worldwide: “the gold standard.”
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Its use is indicated for most osteoarthritic acetabula and especially irradiated bone.
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Its use is contraindicated in poor bone, with acetabular deformities, and with excessive bleeding.
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Long-term results are technique dependent.
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It may become more popular owing to the early success of the reverse hybrid total hip arthroplasty.

The use of cemented all-polyethylene acetabular components has been dramatically reduced in the United States in the past decade as a result of the increasing trend toward noncemented fixation. Nonetheless, it remains the most common form of acetabular fixation worldwide. The reasons for this are numerous. A well-done cemented acetabular component is durable, reproducible, and inexpensive and has a predictable failure mechanism ( Fig. 16-1 ).

Moreover, recent evidence from the Swedish Registry has shown excellent results in younger, active patients with the use of the so-called reverse hybrid total hip arthroplasty (a cemented all-polyethylene acetabulum with a noncemented femur) that has fueled renewed interest in the cemented socket.

In any event, the technique of cementing in an acetabular component should be part of the armamentarium of all U.S. hip arthroplasty surgeons if for no other reason than to better cement a new liner into a well-fixed metal shell during revision surgery.

INDICATIONS AND CONTRAINDICATIONS

For many surgeons, the cemented all-polyethylene acetabulum is indicated for all comers regardless of age, diagnosis, or deformity ( Table 16-1 ). In our experience, the survivorship of a cemented all-polyethylene acetabular component at 10 to 20 years was 98% in patients with a life expectancy of less than 30 years with osteoarthritis and good bone stock. We also prefer to use cemented fixation in the irradiated pelvis owing to the diminished potential for biologic ingrowth.

TABLE 16-1

FAILURE OF CEMENTED ACETABULUM: REVIEW OF THE LITERATURE

Author, Year	Prosthesis	No. Hips	Follow-up Minimum (yr)	Revision Rate (%)
Delee, 1977	Charnley	141	10	NR
Stauffer, 1982	Charnley	231	10	3
Poss, 1988	Mixed	267	11	3.1
Ritter, 1992	Charnley	238	10	4.6
Wroblewski, 1993	Charnley	193	18	3
Kavanagh, 1994	Charnley	112	20	16
Ranawat, 1995	Mixed	236	5	0.8
Mulroy, 1995	CAD, HD-2	105	10	5
Callaghan, 2004	Charnley	27	30	12
Dellavalle, 2004	Charnley	40	20	23

There are, however, certain circumstances in which press-fit fixation has a distinct advantage. These include acetabular deformities such as dysplasia and protrusio acetabuli, inflammatory arthropathies with significant osteopenia, and cases in which excessive acetabular bleeding cannot be controlled with hypotensive anesthesia.

Finally, as a general rule we will avoid cemented fixation in patients with significant cardiopulmonary disease because of the concern for embolic phenomenon during pressurization.

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