How is the hip prosthesis secured?

An artificial hip joint can be secured into the bone in a number of different ways. In essence, there are two main types of fixation – with bone cement or without bone cement:

  • If the bone structure lacks stability, the hip joint replacement is secured using bone cement. Immediately after the operation, the hip endoprosthesis and bone are thus securely bonded.
  • If the patient’s bone is of good quality, the artificial hip joint can be secured using a cementless technique. With such methods, the bone slowly grows into the hip endoprosthesis to form a strong joint after some time.

The correct choice therefore not only depends on the patient’s age but also on the nature of the bone. The surgeon decides upon the appropriate method together with the patient during the preoperative discussion.

Fixation hip joint - cemented hip endoprosthesis

With this method, the artificial acetabular cup and the prosthesis stem are bonded to the bone using bone cement.

For older patients, in particular, the use of bone cement for securing hip endoprostheses is often advisable. The slow bony ingrowth process of the artificial hip joint is avoided and the patient is able to load the leg again soon after the operation.

Furthermore, major studies have shown that cemented hip endoprostheses are particularly durable. This may prevent the necessity of a second operation to change the prosthesis, or at the least postpone it.

Fixation hip joint - cementless hip endoprosthesis

As opposed to cemented techniques, here the prosthesis components are wedged or, in part, screwed into the bone.

To this end, the surgeon has to fit the artificial acetabular cup and the prosthesis stem into bone accurately. Consequently, the metal surfaces of the prosthesis components are in direct contact with the bone.

The latter slowly grows into the prosthesis to form a secure attachment for the artificial hip joint.

Fixation hip joint - hybrid hip endoprosthesis

Hybrid prostheses combine both cemented and cementless fixation methods; the acetabular cup is placed without cement whilst the prosthesis stem is cemented.