Cemented total hip arthroplasty in Germany - An update

Aim: The results of a national survey from 1998 had shown at the time that only around 10% of orthopaedic surgeons in Germany had strictly implemented modern cementing techniques in total hip arthroplasty (THA). The same study was repeated 5 years later to evaluate the current situation and to determine whether modern cementing techniques have become more popular. Methods: A detailed, slightly modified questionnaire regarding cement and bone preparation, cementing techniques on acetabulum and femur, and implant types was sent to 572 German orthopaedic and trauma hospitals, as well as to visiting surgeons with an interest in THA. In total, 293 questionnaires were available for evaluation and statistical analysis. Results: Palacos bone cement remained the most widely used cement (> 90%). The mixing times given varied significantly. Vacuum mixing systems had become more popular (67.9%). In the femur 81.8% of the surgeons attempted to preserve cancellous bone and 57.2% used pulsatile lavage (jet-lavage). Retrograde cement application via a cement gun was done in 71.1%. Cement restrictors were used in more than 95%. Only two-thirds of the surgeons implemented sustained cement pressurisation and preferred a cement mantle thickness > 2mm (64%). Only 16.9% made multiple small acetabular keyholes and 48.6% used jet-lavage. In 73.1% no cement gun was used and in 68.3% the cement was applied at high viscosity. Manual cement pressurisation was done in 58.1%. The Muller straight stem device remained the most popular implant. For only 5 of the over 50 stem designs implanted have long-term results been published as yet. Only 10.6% of surgeons/centres performed > 20 and almost 50% implanted > 100 cemented THAs/year. Conclusion: The results of this survey demonstrated that, in comparison to 1998, the current state of cemented THA, in particular cementing technique has significantly improved. Future emphasis should be on continued surgeon education and training, as the operative, i.e., cementing techniques are of utmost importance for long-term success.