Do we need to vacuum mix or centrifuge cement?

In total hip surgery, the goal of porosity reduction techniques in the preparation of acrylic bone cement is to provide a stronger, more fatigue resistant material between the implant and bone. Conventional mixing of polymethylmethacrylate bone cement produces porosity of 5% to 16%, whereas vacuum mixing or centrifugation reduces the porosity to a range of 0.1% to 3.4%. Multiple studies have demonstrated that this results in a cement that has a significant increase in static and dynamic testing to failure. Fracture of the cement mantle has been found as a part of the failure pattern in many total hip prostheses requiring revision for loosening. Vacuum mixing or centrifugation produces a stronger cement to resist the component of loosening caused by fracture of the cement mantle. Where failure occurs at the bone-cement interface, as in cemented acetabular migration, no improvements from porosity reduction would be expected. Along with enhanced femoral designs, improvements in cement technique with modern methods of bone preparation and administration of the cement have resulted in a marked improvement in clinical and roentgenographic loosening rates in cemented femoral components at medium-term follow-up periods of five to ten years. Intact total hip prostheses, retrieved for reasons other than loosening, at longer-term follow-up periods, have shown intact bone-cement interfaces. However, these specimens have also shown incipient cracks in the acrylic cement that emanate from and connect defects in the cement mantle and at the metal-cement interface. The use of a void-free, structurally stronger material is expected to improve the stability and longevity of the cement supporting femoral implants.