The thickness of the cement mantle surrounding total hip replacements has been used to predict the incidence of aseptic loosening. However little work has been done regarding the significance of the cement mantle distal to the tip of the femoral prosthesis. Results are reported of a radiographic audit study analyzing the thickness of the distal cement column in primary total hip replacement.

In this study the thickness of cement distal to the tip of the femoral prosthesis was measured from 80 post-op AP radiographs taken over a period of 5 months using both the PACS system and plain film x-rays. The mean thickness was 2cm (max 8cm) (min −1.8cm) with a std dev of 1.7cm.

This study demonstrated the wide variation in the thickness of the distal cement column achieved by surgeons. It also highlighted the fact that while 2–5mm is the generally accepted optimal cement mantle surrounding the femoral prosthesis, there is little guidance from the literature with regards the optimal thickness of the cement mantle distal to the tip of the femoral prosthesis. Further work requires to be undertaken to determine the optimal thickness of cement in this area, as well as changes in local surgical practice to ensure the optimal thickness of cement distally is consistently achieved. A re-audit of this work after alterations of surgical technique is desirable.