International Orthopaedics August 2012, Volume 36, Issue 8, pp 1575–1581

Secondary cement injection technique reduces pulmonary embolism in total hip arthroplasty

Schmidutz, F., Düll, T., Voges, O. et al.


Cardio-pulmonary damage due to embolism is a feared complication of cemented hip arthroplasty and can be fatal. Embolic events result from an increased intramedullary pressure during cement and stem insertion and can lead to extrusion of bone-marrow elements into the circulation. To reduce embolism and at the same time achieve an ideal cement mantle, the cement injection stem has been designed. In contrast to conventional stems where cement applied before stem insertion (primary cementing technique), the cement injection stem is positioned first and only then is the cement injected via the stem in a volume- and pressure-controlled fashion (secondary cementing technique).


A randomised trial with 30 patients was performed to evaluate whether this technique is able to reduce embolic events. Patients either received a conventional cemented stem (primary cementing technique) or a cement injection stem (secondary cementing technique). Embolic events were recorded by transesophageal echocardiography at six specific points during the operation and classified from grade 0 to grade 3.


Significantly fewer grade 2 and 3 embolic events were observed in patients receiving the cement injection stem using the secondary cementing technique. Moreover, in the conventional group all patients (100 %) had at least one grade 3 embolus whereas only 20 % with the secondary cementing technique had an embolic event of grade 3.


Secondary cement insertion via the cement injection stem is able to reduce severe embolic events significantly. The technique offers a more gentle cementing technique and therefore appears especially beneficial for patients of advanced age and/or with pre-existing cardio-pulmonary comorbidities.

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