Current status of cemented total hip arthroplasty in Germany

Aim: The correlation between improved cementing techniques and improved long-term results after total hip arthroplasty (THA) is well documented. The purpose of this study was to assess the use of modern cementing techniques in Germany. Methods: A detailed questionnaire regarding cement and bone preparation, cementing techniques on actabulum and femur, and implants used was sent to 554 German orthopaedic and trauma hospitals, as well as to visiting surgeons with an interest in THA. In total, 333 questionnaires were available for evaluation and statistical analysis. Results: In this survey, Palaces bone cement is used in 84%, low viscosity cement in 9%. Cement chilling is performed in 58%. Mixing is done by hand without vacuum mixing systems in 53%, the mixing time is standardised in 66%, For the femur 83% and for the acetabulum 74% preserve cancellous bone, 13% use pulsed lavage. Cement application is done via cement gun in 97%, in 41% in a retrograde manner and in 18% without drainage of the intramedullary canal. A cement pressurising technique is used in 63% for the femur and in 57% for the acetabulum. A cement mantle of less than 2 mm is attempted in 41%. More than 50 different stem designs are implanted with the Muller straight stem being used most often, followed by anatomic designs. Almost 50% of hips are used with a 28 mm head, and almost 50% are implanted with a 32 mm head. Half the heads are ceramic, half are metal. Conclusions: The results from this survey document, that overall only slightly more than 10% of hips are implanted using second/third generation (modern) cementing techniques with application of pulsed lavage. This has implications on the number of arthroplasties that may require revision. From the data available the current status of cementing technique in Germany cannot be judged satisfactory.