The cement in cement technique for revision total hip arthroplasty (THA) has shown good results in selected cases. However, results of its use in the revision of hemiarthroplasty to THA has not been previously reported. Between May 1994 and May 2007 28 (20 Thompson's and 8 Exeter bipolar) hip hemiarthroplasties were revised to THA in 28 patients using the cement in cement technique. All had an Exeter stem inserted at the time of revision. Clinical and operative data were collected prospectively. Clinical evaluation was by the Charnley, Harris and Oxford. Hip scores and radiographs were analysed post-operatively and at latest follow up. The mean age at time of hemiarthroplasty revision was 80 (35 to 93) years. The reason for revision was acetabular erosion in 12 (43%), recurrent dislocation in eight (29%), aseptic stem loosening in four (14%), periprosthetic fracture in two (7%) and infection in a further two (7%) patients. No patient has been lost to follow up. Three patients died within three months of surgery. The mean follow up of the remainder was 50 (16 to 119) months. Survivorship with revision of the femoral stem for aseptic loosening as the endpoint was 100%. Three cases (11%) have since undergone further revision, one for recurrent dislocation, one for infection, and one for periprosthetic fracture. The cement in cement technique can be successfully applied to revision of hip hemiarthroplasty to THA. It has a number of advantages in this elderly population including minimising bone loss, blood loss and operative time

The cement in cement technique for revision total hip arthroplasty (THA) has shown good results in selected cases. However results of its use in the revision of hemiarthroplasty to THA has not been previously reported. Between May 1994 and May 2007 28 (20 Thompson’s and 8 Exeter bipolar) hip hemiarthroplasties were revised to THA in 28 patients using the cement in cement technique. All had an Exeter stem inserted at the time of revision. Clinical and operative data were collected prospectively. Clinical evaluation was by the Charnley, Harris and Oxford hip scores and radiographs were analysed post-operatively and at latest follow up. The mean age at time of hemiarthroplasty revision was 80 (35 to 93) years. The reason for revision was acetabular erosion in 12 (43%), recurrent dislocation in 8 (29%), aseptic loosening in 4 (14%), periprosthetic fracture in 2 (7%) and infection in 2 (7%) patients. No patient has been lost to follow up. 3 patients died within 3 months of surgery. The mean follow up of the remainder was 50 (16 to 119) months. Survivorship with revision of the femoral stem for aseptic loosening as the endpoint was 100%. 3 cases (11%) have since undergone further revision, 1 for recurrent dislocation, 1 for infection, and 1 for periprosthetic fracture. The cement in cement technique can be successfully applied to revision of hip hemiarthroplasty to THA. It has a number of advantages in this elderly population including minimizing bone loss, blood loss and operative time

Study Aims The purpose of this study is to determine whether the cement mantle produced when a suction cement technique is used leads improved radiological results in the medium term. Methods 74 patients who had a cemented total knee replacement were prospectively studied. In 51 patients the cement was applied in a standard fashion. In 23 patients an intraosseous cannula was used to apply suction within the bone to improve cement penetration. The cannula was inserted into the medial femoral condyle and the medial tibial plateau prior to the bone preparation to vent both bones. Suction is applied to help dry the cancellous surface and draw the cement into the bone. The radiological appearance of the tibial components were prospectively examined to for the appearance of bone lysis. Conclusion This study shows that this technique produces superior radiological appearances in the medium term, which may lead to longer implant survival. A previously published study has shown that if total knee replacement is performed without a tourniquet but using the suction cement technique an excellent cement mantle can reliably be produced

Introduction. While fixation on the acetabular side in resurfacing implants has been uncemented, the femoral component is usually cemented. The most common causes for early revision in hip resurfacing are femoral head and or neck fractures and aseptic loosening of the femoral component. Later failures appear to be more related to adverse soft-tissue reactions due to metal wear. Little is known about the effect of cementing techniques on the clinical outcome in hip resurfacing, since retrieval analysis of failed hip resurfacing show large variations. Two cementing techniques have dominated. The indirect low viscosity (LV) technique as for the Birmingham Hip resurfacing (BHR) system and the direct high viscosity (HV) technique as for the Articular Surface replacement (ASR) system. The ASR was withdrawn from the market in 2010 due to inferior short and midterm clinical outcome. This study presents an in vitro experiment on the cement mantle parameters and penetration into ASR resurfaced femoral heads comparing both techniques. Methods. Five sets of paried frozen cadavar femura (3 male, 2 female) were used in the study. The study was approved by ethics committee. Plastic ASR replicas (DePuy, Leeds, UK), femoral head size 47Ø were used. The LV technique was used for the right femora (Group A, fig. 1 and 3) while the HV technigue was used for the left femora (Group B. Fig 2 and 4). The speciments were cut into quadrants. An initiial visual, qualitative evaluation was followed by CT analysis of cement mantle thickness and cement penetration into bone. Results. No significant differences were seen between the four quadrants within each group. The LV technigue resulted in greater cement penetration and increased cement mantle under the top proximally. The HV technique showed less penetration and lower cement mantle. See figures 1–4. Discussion. The aim was to analyze the effect of the cementing techniques used in hip resurfacing practice. The ASR implant was chosen to improve understanding of whether the implant may have been sensitive to cementing techniques and whether an analysis of cementing with the recommended HV technique may assist in explaning the high incidence of short-term ASR revisions due to fractures. Findings for the HV technigue would indicate a superior technique according to consensus in conventional arthropalsty However, this contradicts clinical evidence on resurfacing, where LV cementation has been shown tho be superior. The superficial intergration in the HV technigue may result in only a superficial integration and subsequently suboptimal fixation to bone. To view tables/figures, please contact authors directly

To evaluate the results critically of cemented total hip arthroplasty using a fourth generation cement technique and polished femoral stem, a prospective study was performed in patients under 50 years of age who underwent primary total hip arthroplasty. 55 patients (64 hips) were enrolled in the study (43 were male and 12 were female). Average age of patients was 43.4 years (21–50 years). Elite plus stems (DePuy, Leeds, UK) were cemented and cementless Duraloc cups (DePuy, Warsaw, IN.) were implanted in all hips. 22 mm zirconia femoral head (DePuy, Leeds UK) was used in all hips. All surgeries were performed by one surgeon (YHK). The diagnosis was osteonecrosis (43 hips or 67%), osteoarthritis (5 hips or 4%), O.A. 2° to childhood T.B. or pyogenic arthritis (4 hips or 6%), R.A, (3 hips or 5%), DDH (2 hips or 3%) and others (7 hips or 11%). The average F.U. was 7.2 years (6–8 years). The 4th generation cement technique was utilized including: medullary plug, pulsatile lavage, vaccum mixing of Simplex P cement; cement gun, distal centralizer and proximal rubber seal to pressurize cement. Thigh pain was evaluated using a visual analog scale (10 points). Clinical (Harris hip score) and x-ray follow-up was performed at 6 weeks, 3 months, 6 months, 1 year and then annually. Cementing technique was graded. Abductor moment arm, femoral offset, neck and limb length, center of rotation of hips, cup angle and anteversion were measured in all hips. Linear and volumetric wear were measured by software program. Osteolysis was identified. There was no aseptic loosening or subsidence of components. One hip was revised due to late infection. Incidence of thigh pain was 11% (7 hips). All thigh pain disappeared at 1 year postoperatively. Preoperative Harris hip score was 47.2 (7–67) points and 92.2 (81–100) points at the final F.U. Femoral cementing was classified as grade A in 50 hips (78%), grade B in 6 hips (9%), and grade C1 in 8 hips (13%). There was no cases in grades C2 and D. All bones had type A femoral bone. The average linear wear and annual rate were 1.25 and 0.21 mm, respectively. The average volumetric wear was 473.48 mm3. There was statistically significant relationship between the liner wear, age (under 40), male patient, and the cup angle. Yet there was no statistical relationship between the wear and Dx., wt., hip score, R-O-M, anteversion, anbductor moment arm, femoral offset, neck and limb length and center of rotation of hip. Osteolysis was identified in zone 7A in 6 hips (9%). No hip had distal osteolysis. Advanced cementing technique, polished improved stem design, strong trabecular bone, and utilizing a smaller head and thick polys greatly improved the mid-term survival of the implants in these young patients. Good cementing technique eliminated distal osteolysis and markedly reduced the proximal osteolysis. Yet high linear and volumetric wear of polyethylene liner remains to be a challenging problem

Aim: The purpose of this study was to report our experience mid to long-term results of hybrid cement fixation in revision total knee arthroplasty. Methods: Patients who underwent revision total knee arthroplasty using a hybrid cement technique (press-fit diaphyseal fixation and cemented metaphyseal fixation) with a titanium fluted revision knee implant were reviewed. There were 127 patients. Mean age at surgery was 71 years (range 41–94 years). There were 56 males and 71 females. Mean follow-up was 5 years (range, 2–12 years). A Kaplan-Meier survivorship analysis using an end-point of revision surgery or radiographic loosening was employed to determine probability of survival at 5 and 10 years. Results: 127 patients (135 knees), 31 patients (36 knees) died and 2 patients (2 knees) were lost to follow-up. Six patients (six knees) were revised at a mean of 3.5 years (range 1–8 yrs). Of the 6 revisions, two were for re-infection, two were for (MCL) instability, and two were for aseptic loosening. Mean Knee Society clinical and functional scores were 86 and 55 points, respectively. The mean range of motion was 108 degrees. End of stem pain was not reported in this group of patients. Kaplan-Meier survivorship analysis revealed a probability of survival free of revision for aseptic loosening of 98% at 12 years. Discussion: The results of this study suggest that the use of a hybrid cement technique in revision knee arthroplasty can provide good mid to long-term results. Radiographic analysis has shown continued satisfactory appearances regardless of constraint, stem size and augments. Our experience has shown that the survivorship of a hybrid fixation technique for revision knee arthroplasty is comparable to reported long-term survivorship of cemented revision knee arthroplasty

Purpose. Glenoid component loosening is a common reason for failed total shoulder arthroplasty. Multiple factors have been suggested as causes for component loosening that may be related to cement technique. The purpose of the study was to compare the load transfer across a polyethylene glenoid bone construct with two different cementing techniques. Method. Eight cadaveric specimens underwent polyethylene glenoid component implantation. Four had cement around the pegs only (CPEG) and four had cement across the entire back (CBACK) of the implant including around the pegs. Step loading was performed with a pneumatic actuator and a non-conforming humeral head construct capable of applying loads at various angles. Strain gauges were placed at the superior and inferior poles of the glenoid and position trackers were applied to the superior and inferior aspects polyethylene component. Micro CT data were obtained before and after the loading protocol. Results. During compressive loading, greater tension was recorded with the CBACK technique than with the CPEG technique. Compression was recorded superiorly when load was applied at 30 degrees while tension was recorded inferiorly. Greater displacement occurred with the CPEG group. Failure as defined on micro CT occurred more consistently with the CBACK technique than with the CPEG technique. Conclusion. Tension measurements and upward deflection of the polyethylene with compressive loading at lower angles was unexpected. Early failure of fully cemented glenoids may be due to the fragility of the cement mantle around the periphery of the implant. Tension at the bone cement interface and early cement fracture are unfavorable and this may be a mechanism of implant loosening

Improved cementing techniques have been shown to decrease the rate of aseptic loosening of femoral components of cemented total hip replacements at five to seven years. We now report our results in 105 hips in 93 patients at 10 to 12.7 years (mean 11.2). The improved techniques included use of a medullary plug, a cement gun, a doughy mix of Simplex P and a collared stem of chrome cobalt. Only three femoral components had definitely loosened, none were probably loose and 24 were graded as possibly loose. In contrast, the incidence of radiographic loosening on the acetabular side was 42%. Improved cementing techniques have produced a marked reduction in the rate of aseptic loosening of the femoral component, but the incidence of acetabular loosening is unchanged

Aims. The main aims were to identify risk factors predictive of a radiolucent line (RLL) around the acetabular component with an interface bioactive bone cement (IBBC) technique in the first year after THA, and evaluate whether these risk factors influence the development of RLLs at five and ten years after THA. Methods. A retrospective review was undertaken of 980 primary cemented THAs in 876 patients using cemented acetabular components with the IBBC technique. The outcome variable was any RLLs that could be observed around the acetabular component at the first year after THA. Univariate analyses with univariate logistic regression and multivariate analyses with exact logistic regression were performed to identify risk factors for any RLLs based on radiological classification of hip osteoarthritis. Results. RLLs were detected in 27.2% of patients one year postoperatively. In multivariate regression analysis controlling for confounders, atrophic osteoarthritis (odds ratio (OR) 2.17 (95% confidence interval (CI), 1.04 to 4.49); p = 0.038) and 26 mm (OR 3.23 (95% CI 1.85 to 5.66); p < 0.001) or 28 mm head diameter (OR 3.64 (95% CI 2.07 to 6.41); p < 0.001) had a significantly greater risk for any RLLs one year after surgery. Structural bone graft (OR 0.19 (95% CI 0.13 to 0.29) p < 0.001) and location of the hip centre within the true acetabular region (OR 0.15 (95% CI 0.09 to 0.24); p < 0.001) were significantly less prognostic. Improvement of the cement-bone interface including complete disappearance and poorly defined RLLs was identified in 15.1% of patients. Kaplan-Meier survival analysis for the acetabular component at ten years with revision of the acetabular component for aseptic loosening as the end point was 100.0% with a RLL and 99.1% without a RLL (95% CI 97.9 to 100). With revision of the acetabular component for any reason as the end point, the survival rate was 99.2% with a RLL (95% CI 97.6 to 100) and 96.5% without a RLL (95% CI 93.4 to 99.7). Conclusion. This study demonstrates that acetabular bone quality, head diameter, structural bone graft, and hip centre position may influence the presence of the any RLL. Cite this article: Bone Joint Open 2021;2(5):278–292

We report the long-term outcome of a modified second-generation cementing technique for fixation of the acetabular component of total hip replacement. An earlier report has shown the superiority of this technique assessed by improved survival compared with first-generation cementing. The acetabular preparation involved reaming only to the subchondral plate, followed by impaction of the bone in the anchorage holes. Between 1978 and 1993, 287 total hip replacements were undertaken in 244 patients with a mean age of 65.3 years (21 to 90) using a hemispherical Weber acetabular component with this modified technique for cementing and a cemented femoral component. The survival with acetabular revision for aseptic loosening as the endpoint was 99.1% (95% confidence interval 97.9 to 100 after ten years and 85.5% (95% confidence interval 74.7 to 96.2) at 20 years. Apart from contributing to a long-lasting fixation of the component, this technique also preserved bone, facilitating revision surgery when necessary

Purpose: Cement implantation syndrome characterized by hypotension, hypoxemia, cardiac arrhythmia or arrest has been reported in the literature. Pulmonary embolization is thought to be the main reason. In our institute, however, we have not experienced major hypotension during THA. To improve longevity of THA, interface bioactive bone cement technique combined with modern cementing technique has been used in our institute. Main principle of this technique is smearing hydroxyapatite granules on the dry bony surface followed by cement pressurization. The purpose of the present study was to monitor blood pressure soon after cementing. Method: The present study includes 91 cases of primary THA with an average age at operation of 64 years old (ranging 35 to 85). Under general anesthesia, both components were cemented using antero-lateral approach. Systolic arterial blood pressure was monitored until 5 minutes with 1 minute interval. The maximum regulation (MR%) was calculated as (maximum change blood pressure – blood pressure before cement insertion) divided by blood pressure before cement insertion. Results: No major complications such as cardiac arrest were observed. In most of the cases, blood pressure increased until 4 minutes for the acetabular side and 2 minutes for the femoral side, and then returned to the blood pressure before cement insertion gradually. In the acetabular side, MR% was 10±13 (−19–40)%. In 52 joints (57.1%), MR% was between 10 to 40 %. In the femoral side, MR% was 5±12 (−20 to 31)%. In 32 joints (35.2%), MR% was between 10 to 31 %. Conclusion: In the present study, major hypotension was not observed. Blood pressure increases if left ventricle reacts to the pulmonary hypertension caused by micro-embolization. If major pulmonary embolization occurs, blood pressure decrease because left ventricle can not compensate for major pulmonary hypertension caused by mayor pulmonary embolization. By good cementing technique which includes washing out debris or fat and obtaining dry bony surface just before cementing, blood pressure soon after cementing was increased

Background. Cement implantation syndrome characterized by hypotension, hypoxemia, cardiac arrhythmia or arrest has been reported in the literature. The purpose of the present study was to monitor blood pressure soon after cementing. Methods. The present study includes 178 cases 204 joints of primary THA with an average age at operation of 64.5 years old (ranging 35 to 89). Under general anesthesia, both components were cemented using antero-lateral approach. Systolic arterial blood pressure during cementing acetabular and femoral components was monitored until 5 minutes with 1 minute interval. The maximum regulation ratio (MRR) was calculated as (maximum change blood pressure – blood pressure before cement insertion) divided by blood pressure before cement insertion. Results. No major complications such as cardiac arrest were observed. In most of the cases, blood pressure increased until 4 minutes for the acetabular side and 2 minutes for the femoral side, and then returned to the blood pressure before cement insertion gradually. In the acetabular side, average MRR was 11.2% (SD, 15.9; range, −26 to 80). Ｉn the femoral side, MRR was 6.4% (SD, 14.9; range, −31 to 65). There was statistical correlation between categories of MRR in the acetabular side and age at operation, the status of bleeding control of the acetabular side. When the bleeding control was judged as complete, blood pressure showed less tendency to decrease. When the bleeding control was judged as good, blood pressure showed more tendency to decrease. Conclusion. In the present study, major hypotension was not observed. Using third generation and IBBC cementing technique, when the bleeding control was judged as complete in the acetabular side, blood pressure showed less tendency to decrease

Improved cement technique by interposing less than two layers of hydroxyapatite (HA) granules between bone and bone cement at the cementing (Interface Bio-active Bone Cement : IBBC) have been performed in total knee arthroplasty (TKA) since 1987. We performed IBBC technique in 153 knees (130 patients) in TKA from 1987 to 1993. One hundred and forty knees (120 patients) could be followed up clinically and radiologically. Follow up rate was 91.5%. A mean follow-up period was 9.5 years (6 to 13 years) after surgery. As a control, clinical results of TKA with conventional cementing (Non-IBBC) which were operated in 44 knees (44 patients) in 1986 were used. In IBBC cases, radiolucent lines on the tibial components were seen 7.1%, 2.9%, 1.4%, 3.6%, 0%, 0% and 0% at Zone ‡T to ‡Z of the anteroposterior view, while in Non-IBBC cases, 40.9%, 13.6%, 9.1%, 27.3%, 11.4%, 4.5% and 13.6% at Zone ‡T to ‡Z, respectively. In IBBC cases peri-prosthetic osteolysis of the tibial components were seen in three knees (2.1%), while 29.5% in Non-IBBC cases. Aseptic loosening of the tibial component was only one case (0.7%) in IBBC cases, while 9.1% in Non-IBBC cases. In IBBC, bone cement bound to HA mechanically immediately after surgery and HA granules bound to the bone physicochemically after bone ingrowth into the spaces around the HA granules. In Non-IBBC, spaces will appear between bone and bone cement due to osteoporosis and/or atrophy after long years. However, in IBBC, bone and bone cement will contact by interposing HA forever due to osteoconductive effect of HA. In conclusion, the IBBC has significantly reduced the incidence of radiolucent lines and periprosthetic osteolysis in TKAs. IBBC is a method combining the advantage of cementless HA coating and bone cement

INTRODUCTION. we have previously reported that bone preparation is quite precise and accurate relative to a preoperative plan when using a robotic arm assisted technique for UKA. However, in that same study, we found a large variation between intended and final tibial implant position, presumably occuring during cement curing. In this study, we reviewed a subsequent cohort of patients in which the tibial and femoral components were cemented individually with ongoing evaluation of tibial component position during cement curing. METHODS AND MATERIALS. Group 1 comprised the simultaneous cementing techniquegroup of patients, previously reported on, although their x-rays were re-analyzed. Group 2 consisted of the individual cementing technique cohort. All implants were identical, specifically a flat, inlay all-polyethylene tibial component. Postoperative x-rays from each cohort of patients were evaluated using image analysis software. Statistical evaluation was performed. RESULTS. In Group 1, average bone preparation was 5.13 + 2.70 degrees of varus and 7.40 + 2.59 degrees of posterior slope. Final implant position was 3.56 + 1.93 degrees of varus and 5.19 + 3.37 degrees of slope. The variance from intended position was 2.31 + 1.74 degrees of varus and 3.80 + 2.90 degrees of slope. For Group 2, average bone preparation was 5.26 + 3.70 degrees of varus and 5.49+ 2.39 degrees of posterior slope. Final implant position was 6.58 + 3.40 degrees of varus and 6.11 + 2.39 degrees of slope. The variance from intended position was 1.82 + 1.42 degrees of varus and 1.39 + 1.48 degrees of slope. ANOVA revealed no differences between groups regarding bone prep in the coronal plane, final implant slope, or variation from intended coronal position. However, bone prep in the sagittal plane showed statistically significant more slope for Group 1 (p = 0.03), increased slope in Group 2 (p=0.004), and greater variation from intended sagital position for Group 1. CONCLUSIONS. Independent cementing of implants showed decreased variation in final tibial component position. However, some implants showed up to 6 degrees of malposition from the intended position. We believe this to be a shortcoming of the inlay style of tibial component for UKA, which even cannot be overcome with the precision and accuracy of a robotic arm assistant

We have used Interface Bioactive Bone Cement (IBBC) in all cases of total joint arthroplasties since 1987. The method is improved cement technique by interposing less than two layers of hydroxyapatite (HA) granules between bone and the polymethylmethacrylate (PMMA) bone cement. We report one patient who underwent revision surgery after total knee arthroplasty (TKA) using IBBC. The patient is a woman aged 70 years at the time of revision surgery. Right TKA was performed with the diagnosis of rheumatoid arthritis. An alumina ceramic total knee prosthesis was inserted using IBBC. Pain and walking ability were once improved after the primary TKA. However, the gait disturbance recurred after the patient fell on the ground. Radiographic findings showed severe genu varum, but neither radiolucent lines around the components nor migration of the components were seen. This was revised with semiconstrained prosthesis for the purpose of improving lateral instability at 31 months after the primary TKA. Avulsion of fibular attachment of collateral ligament was seen at the time of the revision surgery. As PMMA cement was strongly adhered to the bone, it was removed together with cancellous bone. Histologically, HA granules bound to the bone directly after bone ingrowth into the spaces around the HA granules. This is the reason we have described IBBC as a method having the both advantages of cementless HA coating and PMMA bone cement. After the revision surgery, the walking ability was improved. In conclusion, this case showed excellent characteristics of IBBC

Revision of the femoral component during revision hip arthroplasty may pose significant technical challenges, most notably femoral fracture and bone perforation. The in-cementing technique allows use of the original bone-cement interface which has been proven to be biomechanically stronger than recementing after complete removal of the original cement mantle.

This study reviews a series of 54 consecutive revision hip arthroplasty procedures carried out by the senior author using the in-cementing technique from November 1999 to March 2003. Patients were followed up clinically and radiologically with serial outpatient reviews and their functional outcome was assessed using the Harris hip scoring system, the Oxford hip scoring system and the University of California at Los Angeles (UCLA) activity profile. Their physical and mental well-being was also assessed using the SF-36 self-questionnaire.

Fifty-four procedures were performed on 51 patients. There were 31 males and 20 females. The average age was 70.3+/-8.1 years (range: 45-83 years). The average time to revision from the original procedure was 132.8+/-59.0 months (range: 26-286 months). The average length of follow-up was 29.2+/-13.4 months (range: 6-51 months) post revision arthroplasty. Two patients suffered dislocations, one of which was recurrent and was revised with a Girdlestone's procedure. No patient displayed any evidence of radiographical loosening. The average Harris hip score of the study group was 85.2+/-11.6 (range: 51.9-98.5). The average Oxford hip score recorded was 19.6+/-7.7 (range: 12-41) and the average UCLA activity profile score was 5.9+/-1.6 (range: 3-8). The SF-36 questionnaire had an average value of 78.0+/-18.3 (range: 31.6-100).

In conclusion, the results of this study show excellent clinical and radiological results of the in-cementing technique with high patient satisfaction in terms of functional outcome. This technique merits consideration where possible in revision hip arthroplasty.

We have evaluated the effect of vacuum aspiration of the iliac wing on the osseointegration of cement into the acetabulum. We entered a total of 40 patients undergoing primary total hip arthroplasty into two consecutive study groups. Group 1 underwent acetabular cement pressurisation for 60 seconds before insertion of the acetabular component. Group 2 had the same pressurisation with simultaneous vacuum suction of the ilium using an iliac-wing aspirator. Standard post-operative radiographs were reviewed blindly to assess the penetration of cement into the iliac wing. Penetration was significantly greater in the group with aspiration of the iliac wing.

To assess the effect of improved methods of femoral cementing on the loosening rates in young patients, we reviewed 50 'second-generation' cemented hip arthroplasties in 44 patients aged 50 years or less. The femoral stems were all collared and rectangular in cross-section with rounded corners. The cement was delivered by a gun into a medullary canal occluded distally with a cement plug. A clinical and radiographic review was undertaken at an average of 12 years (10 to 14.8) and no patient was lost to follow-up. No femoral component was revised for aseptic loosening, and only one stem was definitely loose by radiographic criteria. By contrast, 11 patients had undergone revision for symptomatic aseptic loosening of the acetabular component and 11 more had radiographic signs of acetabular loosening.