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FEMORAL CEMENTATION GRADE – SPECIALIST VERSUS GENERALIST

Dept. of Trauma & Orthopaedic Surgery, South Tees Acute Hospitals NHS Trust, Middlesbrough General Hospital, Middlesbrough TS5 5AZ.

We have performed a study comparing the radiological results of Total hip replacements performed by a single, experienced specialist hip surgeon with those reported from the Trent Regional Arthroplasty Study (TRAS) [presented at BOA congress 2000]. Results from TRAS have revealed that inadequate cementation grades and a cement mantle width of <2mm were the most significant associations predicting early aseptic loosening. Interestingly, their respective incidences were as large as 20% and 50% in a random sample of THRs from the TRAS register.

Data is lacking as to whether poorer radiographic cementation grades have a trend towards individual surgeons or whether they are more evenly distributed amongst the surgical population including those adhering to modem techniques.

Therefore, we have undertaken an independent review of A-P and lateral radiographs of 33 consecutive Charnley THRs performed by a specialist hip surgeon using carefully controlled modem cementing techniques and compared the results with the same random cohort of THRs from the TRAS.

Our results show that the specialist surgeon achieved a significantly higher proportion (82%) of complete cement mantles (>2mm in all zones) than those achieved by TRAS (50%) [Chi²=7. 79, p=0. 0052]. This suggests that improved cement mantles can be achieved by the adoption of carefully controlled modem cementing techniques. However, use of the Barrack system of grading was unable to detect differences in cementation quality between specialist (88%) and TRAS group (81%) [Chi²=0. 235; p=0. 631 suggesting less sensitivity in this technique for assessing cementation quality. These results are important for the following reasons. Achievement of adequate mantle (>2mm) can be improved upon by adoption of carefully controlled modem cementing technique. However, regardless of the method of assessment of cementation quality, approximately 18% will appear ‘inadequate’ despite modern techniques suggesting that factors outside the surgeon’s control are involved in determining cementation grade. This has important medico-legal implication in the current climate in which surgeons are being criticised, in negligence cases arising out of the 3M Capital Hip experience, for achieving ‘inadequate’ cementation.

The abstracts were prepared by Mr Simon Donell. Correspondence should be addressed to him at the Department of Orthopaedics, Norfolk & Norwich Hospital, Level 4, Centre Block, Colney Lane, Norwich NR4 7UY, United Kingdom