DOI: 10.1093/bjs/znad258.702 ISSN:

1167 Assessing Femoral Cementing Qualities in Total Hip Replacements

C Cooper, S Tse, A Dick
  • Surgery



High quality cement mantles are important to the long-term survival of femoral stems in total hip replacements (THRs). There’s variability in the quality of cement mantles and positioning of cement restrictors. The audit aim was to assess current practice of cemented femoral stems in THRs against local standards.


All patients who underwent THR with a cemented femoral stem between March 2021 and April 2022 were included in the study. TraumaCad software was used to retrospectively collect data on post-operative radiographs for overall cement mantle quality, coronal stem alignment, tip of stem to radio-opaque cement restrictor marker distance, and tip of stem to end of cement mantle distance (Gruen Zone 4).

We audited against the following standards:90% of stems have Barrack and Harrison Grade A ratingKhalily angle <5°Tip of stem to radio-opaque marker of 20-40mmGruen zone 4 of 10-30mm


126 cemented femoral stems were included. Evaluation of Barrack grading showed 55% (N = 69) compliance with grade A, 45% (N = 57) of stems were grade B, with 0% grade C or D. Mean Khalily angle was 1.67° (98.4% compliance). Mean distance from tip of stem to cement restrictor was 36.5mm (60% compliance). Mean length of cement mantle in Gruen zone 4 was 18.9mm (71% compliance).


Overall, cement mantle quality and femoral stem coronal alignment were acceptable. There is variability of cement mantle thickness below the tip of the stem and with restrictor placement. We recommend re-auditing following junior surgeon cementing technique education.

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