For at least a decade many publications have been pointing out the significance of mixing and cementing techniques, especially in connection with the risk of subsequent revisions as a result of aseptic loosening. “The link between improved cementing technique and improved long-term results in hip endoprosthetics is regarded as certain” (Breusch SJ, Berghoff R, Schneider U, Weiß G, Simank H.-G, Lukoschek M. Ewerbeck V. Der Stand der Zementiertechnik in Deutschland, Z. Orthop. 1999; 137: 101-107).

The elements of modern cementing technique include mixing the cement in a vacuum and cleansing the bone surface by jet lavage before introducing the cement.

Cement mixed by hand in the conventional way is porous. It contains up to 30% air. Cement mixed in a vacuum can be almost non-porous. Reduced porosity increases the cement’s strength (endurance and flectional resistance) considerably. In the medium term the risk of revision is reduced significantly. This is borne out by the Swedish prospective multi-center study of 169,419 primary implants (risk quotient 0.74 after 8 years). (Malchau H, Herberts P, Söderman P, Odén A. Prognosis for total hip arthroplasty. Updating and validation of data in the Swedish National Hip Arthroplasty Register 1979-1998. Presented at the Scientific Exposition of the 67th Annual Meeting of the American Academy of Orthopaedic Surgeons, March 15-29, 2000, Orlando, FL).

In addition, vacuum mixing reduces the quantity of monomer fumes emitted to below the detection limit. It reduces to a minimum the exposure of operating room staff to monomer fumes and improves their working conditions.

Jet lavage cleansing of the bone surface prior to cementing increases the strength of the bone-cement interface and reduces blood penetration into the cement. This increases the bone cement’s mechanical strength. It also helps to prevent bone marrow embolisms and thromboses.

The Swedish Hip Arthroplasty Register has recorded cementing techniques since 1979. The data collected shows that implants have a significantly longer lifespan if a modern cementing technique is used.