The significance of the micropores at the stem-cement interface in total hip replacement

Cemented total hip replacement has been performed worldwide to treat patients with osteoarthritis and osteonecrosis, with aseptic loosening as its primary reason for revision. It has been indicated that the stem-cement interfacial porosity may contribute to the early loosening of cemented hip prosthesis. In addition, it is generally accepted that the micropores in bone cement surface and in the bulk material are detrimental to the mechanical integrity of bone cement and act as stress concentrators, resulting in generation of fatigue cracks in the cement mantle. Furthermore, it was demonstrated that the micropores also play an important part in initiation and propagation of fretting wear on polished femoral stems. Taking this into consideration, a detailed review of the potential significance of the micropores in bone cement and the methods that could be employed to reduce porosity is given in this article. It was considered that modern cementing techniques are clinically beneficial and should be applied in surgery to further improve the survivorship of cemented total hip replacement.