Elderly patients undergoing both elective and nonelective hip arthroplasty contribute markedly to health care spending, and the current aging population is likely to require even more resources. Several national joint replacement registries show a lower risk of revision surgery in patients older than 75 years who received cemented femoral components compared with cementless implants for primary total hip arthroplasty. Despite a higher incidence of early periprosthetic femoral fracture, noncemented femoral components are being used with increasing frequency in elderly patients worldwide. Improvements in cementing technique and modifications to cemented stem design over several decades allow surgeons to obtain femoral component fixation in poor-quality bone with a relatively low risk of complications. Achieving durable cemented stem fixation requires the surgeon to understand the basic handling properties of cement, how to prepare the femoral bone, and differences in stem design and surface finish.
From Dunedin School of Medicine, University of Otago, Dunedin, New Zealand (Dr. Scanelli), the Shenandoah Valley Orthopedics, Fishersville, VA (Dr. Reiser), Riverside Orthopedics, Williamsburg, VA (Dr. Sloboda), and Virginia Tech Carilion School of Medicine, Roanoke, VA (Dr. Moskal).
Dr. Sloboda or an immediate family member has stock or stock options held in Pacira Pharmaceutical. Dr. Moskal or an immediate family member has received royalties from DePuy Synthes; is a member of a speakers' bureau or has made paid presentations on behalf of Medtronic and Stryker; serves as a paid consultant to Corin USA, Medtronic, and Stryker; has stock or stock options held in Invuity; and serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons and the American Association of Hip and Knee Surgeons. Neither of the following authors nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Scanelli and Dr. Rieser.