Migration of the Acetabular Component: Effect of Cement Pressurization and Significance of Early Radiolucency: a Randomized 5-year Study Using Radiostereometry

Background: Cementing technique is a crucial factor in prosthesis fixation. No randomized studies have been published, however, comparing the outcome of conventional fingerpacking with the outcome of pressurization of the cement prior to cup insertion.

Patients And Methods: We randomized 50 THAs to either fingerpacking or sequential pressurization (including individual pressurization of each anchorage hole) and followed the patients with RSA for 5 years. The penetration of cement into the anchorage holes was measured on digital radiographs. Postoperative radiolucent lines around the cup were correlated to later RSA results. For clinical evaluation, we used SF-36 and HHS.

Results: The pressurized group of THAs was more stable regarding changes in inclination. We found no other difference in the migratory behavior. The cement penetration into the anchorage holes was deeper with the pressurization technique than with fingerpacking. For the whole group taken together, there was a strong relation between the presence of radiolucent lines as measured on the postoperative radiograph and later migration observed by RSA at 2 and 5 years.

Interpretation: Pressurization of the cement produced better cement penetration and increased the cup stability in terms of changes in inclination. Early findings of radiolucent lines can predict later unfavorable cup migration.