Femoral cement pressurization in hip arthroplasty: a laboratory comparison of three techniques.

BACKGROUND: Several cementing techniques are used for the proximal femur. MATERIAL AND METHODS: We evaluated 3 femoral cement pressurization techniques (standard, pressurizer in situ, and thumb pressurization) in 12 plastic femurs, with 4 sets of observations for each technique. Intramedullary pressure readings were obtained using proximal and distal pressure monitoring transducers. The peak pressure and the length of time for which the pressure was above a particular cutoff level (5 KPa and 100 KPa) were compared for the different techniques. RESULTS: We found significant differences between the 3 cementing techniques in the peak pressure and the length of time for which the pressure was above 100 KPa. The pressurizer in situ technique gave higher peak pressure (p < 0.001), both proximally (398) and distally (597). The standard technique produced a pressure of 100 KPa for a longer duration, both proximally and distally (mean 67 sec and 45 sec, p < 0.001) compared to the other two techniques (less than 5 and 17 sec for the thumb pressurization technique and the pressurizer in situ technique, respectively, both proximally and distally). Although the pressurizer in situ technique produced the highest peak pressure, the standard technique produced an optimum pressure of longer duration. INTERPRETATION: The standard technique appears to be adequate for achievement of optimum pressurization during femoral cementing without increased risk of embolization.