Cemented Total Hip Arthroplasty in Germany - Update 2010

Background: The results of a national survey from 1998 showed that only around 10% of orthopaedic surgeons in Germany had strictly implemented modern third-generation cementing techniques in total hip arthroplasty (THA). A 2005 update showed an improvement up to 29.4%. The study was repeated in 2010 in order to evaluate the current situation and to determine whether modern cementing techniques have become more popular. Material and Methods: A detailed, slightly modified questionnaire regarding cement and bone preparation, cementing techniques on acetabulurn and femur, and implant types was sent to 492 German orthopaedic and trauma hospitals, as well as to visiting surgeons with an interest in THA. The survey was conducted over 6 months. The response rate was 51.8%, 255 questionnaires were available for evaluation and statistical analysis. Results: Palacos R+G bone cement remained the most widely used cement (52.2%). The mixing times given varied significantly. Vacuum mixing systems have again become more popular (85.2%). In the femur 78.6% of the surgeons attempted to preserve cancellous bone and 77.8% used pulsatile (jet) lavage. Retrograde cement application via a cement gun was done in 85.8%. Cement restrictors were used in more than 98%. Only 72.7% of the surgeons implemented sustained cement pressurisation and preferred a cement mantle thickness over 2 mm (55.2%). Only 18.1% drilled multiple small acetabular keyholes and 66.5% used jet lavage. In 67.9% no cement gun was used and in 70.7% the cement was applied at high viscosity. Cement pressurisation was done manually in 89.1%. The Muller straight stem device remained the most popular implant. Only 7.4% of the centres implanted less than 20 and 40.3% more than 100 cemented stems per year, whereby higher THA volumes correlated with better cementing technique. Conclusion: The results of this survey demonstrate that, in comparison to 2005, the current state of cemented THA, in particular cementing technique has generally significantly improved. Future emphasis should focus on continued surgeon education and training, as the cementing techniques are of utmost importance for long-term durability.