Total Hip Replacement with Fixation by Acrylic Cement

Total hip replacement utilizing the McKee-Farrar prosthesis and acrylic cement relieved pain in seventy-nine of 100 diseased hips and improved the stance, walking function, and mobility of these same hips for periods of follow-up ranging from two to four years. The results have been so-satisfactory to the patients that continued use and further development of this type of operation is certainly warranted. Basic long-term questions, however, remain to be answered in connection with the use of an all-metal bearing with skeletal fixation by acrylic cement. A cautious attitude toward the use of this technique of total hip replacement should be continued. The patients selected for this procedure should be the elderly and infirm, or patients with desperate and difficult clinical problems which cannot be solved adequately in any other way. The operation should be performed only after the patient has been informed of the unknowns involved. The incidence of wound complications in this series was high. However, only the tendency to subclinical or latent deep infection seemed significantly higher with this type of procedure than with interpositional or femoral replacement arthroplasty without acrylic cement. To avoid infection, standards of surgical asepsis more stringent than those hitherto accepted seem indicated. Prosthetic loosening even in the absence of infection was also a problem. Patient selection, operative technique, and postoperative management probably contributed importantly to this complication. Appropriate changes in methodology have been made, but it is too early to evaluate their efficacy.