Getting optimal cup placement and cement mantle in a cemented acetabular cup: A novel technique

Abstract Background: Total hip arthroplasty (THR) is one of the most successful procedures in the history of orthopaedics. With increasing popularity of uncemented THR in the last 10–15 years, a well done cemented THR seems to be a forgotten art. While most surgeons are well acquainted with executing a cemented stem there seems to be some hesitance or discomfort in executing a good cemented acetabular cup. The routinely available instrument provided by most implant companies, makes it a little difficult in achieving an optimal cup position and adequate cement pressurisation both at the same time. Hence, we have evolved our technique by segregating the process of cement pressurisation and maintaining cup position using different instruments. This technique is simple, reproducible and can be executed with routinely available instruments. This technique helps us get good cup position (anteversion and inclination) and a good cement mantle in all three zones consistently. Method: The technique was used in over 47 cases of cemented total hip replacements at multiple hospitals and nursing homes starting 2022. Post op antero posterior X-ray was used to determine acetabular inclination angle and the quality of cement mantle. A minimum mantle of 2 mm in all three zones of Delee and Charnley was deemed to be optimum. Anteversion was assessed intraoperatively using the reference to TAL and relation to the acetabular wall and secondarily by stability of the hip and range of motion. Post operative radiological assessment of anteversion angle by a frog leg lateral Xray was difficult due to practical reasons and remains a limitation of the study. Results: The mean follow up was 1.6 years (2 months to 2.5 years). The mean inclination angle was 41° (34°–49°). An optimum cement mantle was seen in 43 of the 47 cases. In four cases the cement mantle was deemed suboptimal (all in zone 1). There was no case of lysis or loosening. Conclusion: This is a simple and reproducible technique of executing a cemented cup. Early radiological results are promising. Long term radiological and clinical follow up is needed to further validate this technique.