Stability and Occlusion of Six Different Femoral Cement Restrictors

Cement restrictors play an integral part in modern cementing technique in total hip arthroplasty. By sealing the femoral cavity, distal cement leakage is prevented and the intramedullary pressure is increased. Thus both the ability of the cement to interdigitate with bone and secondarily the shear strength of the cement bone interface are enhanced. For this purpose various plug models are available, which differ in design and material. Six different cement restrictors were investigated in a biomechanical model with regard to intramedullary implantation pressure, insertion force and in particular stability and sealing ability. We performed a pressure and stability measurement in artificial saw bones during the insertion and standardised cement application and pressurisation. The REX Cement Stop, which is the only intramedullary expandable cement restrictor, yielded the best results in all of the parameters investigated. The flexible gelatin plugs (Biostop G, IMSET, Plugin Tech) also reached a sufficient canal occlusion and stability, but with slightly higher insertion pressures and forces. However, the more rigid polyethylene restrictors (BUCK, Universal Cement Restrictor) showed a reduced stability and poor sealing ability. The latter devices cannot be recommended for use with modern cementing techniques