The case for cementing all femoral components in total hip replacement.

Two important new observations underlie the recommendation that it is advisable to cement all femoral components of total hip replacement (THR). First, it is now clear that improved cementing techniques have remarkably extended the durability of the cemented fermoral fixation and markedly reduced the incidence of lysis. Second, the incidence of femoral lysis around all noncemented femoral components that have been reported with minimum 5-year follow-up is high, increasing and alarming. With good cementing in primary THR, the incidence of femoral revision for aseptic loosening at 15 to 18 years after the initial operation is only 2% to 3%, even in those 50 years of age and younger. Moreover, lysis is rare. Similarly, with improved femoral cementing, femoral revision is also far more effective. The juxtaposition of the excellent results with improved cementing and the high and rising lysis rates around noncemented femoral components clearly mandate the use of contemporary cementing procedures for all femoral components, regardless of the age or sex of the patient, the diagnosis and whether the procedure is a primary or revision one.