Fixation of the Cemented Stem: Clinical Relevance of the Porosity and Thickness of the Cement Mantle

Philippe Hernigou*, 1, Gildasio Daltro2, Charles Henri Flouzat Lachaniette1, Xavier Roussignol1, Martin Mukisi Mukasa3, Alexandre Poignard1
1 Hôpital Henri Mondor - 94010 CRETEIL, France
2 Hospitals Edgar Santos, University Federal of Bahia, Salvadore, Brazil
3 Hospital de Point à Pitre- Guadeloupe, France

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© Hernigou et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Orthopaedics Surgery, University Paris XII, Hospital Henri Mondor, 94010 Creteil, France; Tel: 33149812601; Fax: 33149812608; E-mail:


The aim of this review paper is to define the fixation of the cemented stem. Polymethyl methacrylate, otherwise known as “bone cement”, has been used in the fixation of hip implants since the early 1960s. Sir John Charnley, the pioneer of modern hip replacement, incorporated the use of cement in the development of low frictional torque hip arthroplasty. In this paper, the concepts of femoral stem design and fixation, clinical results, and advances in understanding of the optimal use of cement are reviewed. The purpose of this paper is to help understanding and discussions on the thickness and the porosity of the cement mantle in total hip arthroplasty. Cement does not act as an adhesive, as sometimes thought, but relies on an interlocking fit to provide mechanical stability at the cement–bone interface, while at the prosthesis– cement interface it achieves stability by optimizing the fit of the implant in the cement mantle, such as in a tapered femoral stem.