Cemented vs Uncemented Hip Replacement
One of the most common questions patients ask before hip replacement surgery is whether their implant will be cemented in or press-fitted. Both fixation methods are safe and highly effective. The choice depends on your age, bone quality, activity level, and the specific implant being used. This page explains what each method involves, when each is preferred, and what the outcome data shows.
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How the Implant Is Fixed
What Is the Difference Between Cemented and Uncemented Hip Replacement?
When a hip replacement is performed, the surgeon must fix the new components securely to your bone. There are two main ways this is done: using bone cement, or relying on a precise press-fit with bone ingrowth. The choice between them is one of the most important technical decisions in your operation.
Cemented fixation: bone cement (polymethylmethacrylate, PMMA) is mixed, applied to the prepared bone cavity, and the implant is inserted while the cement is still pliable. It hardens within minutes, creating an immediate and strong mechanical bond. The bone does not need to grow into the implant; the cement fills the gap and locks everything in place from the start.
Cementless (uncemented) fixation: the component is machined to fit precisely against the prepared bone surface. The outer surface is porous or coated with hydroxyapatite to encourage bone to grow into it over 6 to 12 weeks, creating a durable biological bond. Initial stability comes from the tightness of the press-fit while that ingrowth is taking place.
Both methods have more than 30 years of outcome data and excellent long-term results when used appropriately and in the right patient. Neither is universally superior; the right choice depends on your individual circumstances.
| Feature | Cemented Fixation | Cementless (Uncemented) Fixation |
|---|---|---|
| Fixation method | Bone cement bonds implant to bone immediately | Press-fit; bone grows into porous surface |
| How it works | PMMA cement fills gap between implant and bone, hardening within minutes | Tight mechanical fit plus hydroxyapatite or porous coating promotes biological ingrowth |
| Primary stability | Immediate; weight-bearing from day 1 | Relies on tight fit; bone ingrowth over 6 to 12 weeks |
| Long-term fixation | Mechanical bond between cement and bone | Biological bond: bone integrated into implant surface |
| Best suited for | Older patients (70+), osteoporosis, lower activity, Dorr type C femoral canal | Younger patients (under 70), good bone quality, higher activity levels |
| Femoral stem examples | Exeter (Stryker), C-stem (DePuy) | Corail (DePuy), Trident (Stryker) |
| Acetabular cup | Cemented cups less common; usually used as hybrid with cementless cup | Cementless cup is standard in most primary total hip replacements in the UK |
| NJR survival (approx 10 yr) | ~95% in appropriately selected patients | ~95% in appropriately selected patients |
Which Is Right for You
When Is Cemented Fixation Preferred?
The decision between cemented and cementless fixation is not arbitrary; it is based on a structured assessment of your bone, your age, your activity level, and the implant system planned. The following factors guide that decision.
Cemented fixation indications
Cemented fixation is generally preferred for older patients, broadly those over 70 to 75, where bone quality may not support the reliable bone ingrowth that cementless fixation depends on. It is also the preferred choice where osteoporosis has been confirmed on a DEXA scan or inferred from X-ray appearances.
Canal morphology matters too. A Dorr type C femoral canal (wide, with thin cortical bone) may not allow a cementless stem to achieve the tight press-fit needed for stable early fixation. In this situation, cemented fixation is safer and more reliable.
The Exeter cemented stem has some of the highest long-term survival data of any hip implant in the National Joint Registry, demonstrating that cemented fixation, used appropriately, is not a compromise; it is the right choice for many patients.
Cementless (uncemented) fixation indications
Cementless fixation is generally preferred for younger patients, broadly those under 70, with good bone quality and higher activity levels. In this group, the biological fixation created by bone ingrowth into a porous surface is durable and well-suited to a long expected implant lifespan.
Cementless fixation also avoids the theoretical risk of bone cement implantation syndrome, a rare but serious cardiovascular event that can occur during femoral cementing, particularly in patients with cardiorespiratory compromise. For at-risk patients, a cementless stem may be the safer intraoperative choice.
Almost all acetabular cups used in the UK today are cementless, regardless of which femoral fixation is chosen, because the socket reliably supports bone ingrowth in the vast majority of patients.
A Hybrid Option
What Is a Hybrid Hip Replacement?
Many surgeons, including those practising in UK arthroplasty centres, use a hybrid approach: a cementless acetabular cup combined with a cemented femoral stem. This combination reflects the different biological characteristics of the two sides of the joint.
The acetabulum (socket) tends to have good cancellous bone that supports reliable ingrowth into a cementless cup, even in older patients. The femoral canal, by contrast, is more variable; in patients with osteoporosis or a wide Dorr type C canal, a cemented stem provides more predictable and secure long-term fixation than a cementless stem that cannot achieve adequate initial press-fit.
The reverse hybrid (cementless stem, cemented cup) is less commonly used. It may be appropriate in specific situations where the femoral anatomy strongly favours cementless fixation but the acetabular bone stock makes cementless cup fixation less reliable, though this is uncommon in routine primary hip replacement.
The key message is that the choice of fixation is made component by component, not as a single decision for the whole joint. The acetabulum and femur are assessed separately, and the best fixation method for each is chosen on its own merits.
What the Evidence Shows
Do Cemented and Cementless Hip Replacements Last as Long?
Both cemented and cementless hip replacements achieve approximately 95% implant survival at 10 years in appropriately selected patients, according to National Joint Registry data. This is a critical point: the survival figures are comparable not because the techniques are identical, but because each performs best when used in the patient population it is designed for.
At 20 years, some studies show slight advantages for cemented stems in older populations, where bone quality and biological ingrowth capacity diminish over time. Cementless stems show excellent long-term durability in younger, more active patients, where bone ingrowth is robust and sustained.
Revision rates across the registry are driven more by bearing surface wear, patient factors such as age and BMI, and implant design decisions than by the choice of fixation method alone. A well-executed cemented hip replacement in the right patient will outlast a poorly selected cementless hip replacement in the wrong one.
The conclusion from the evidence is clear: there is no universally superior fixation method. The best outcome comes from careful patient selection, precise surgical technique, and choosing the fixation strategy that best matches the individual's anatomy, age, and activity demands.
Hip Replacement in Birmingham
Personalised Implant Selection at Every Consultation
The choice of cemented or cementless fixation is not made by protocol. Mr Hussain reviews your X-rays, bone quality, age, activity level, and the specific implant planned before recommending a fixation strategy. With 5,000+ procedures and a 4.98 Doctify rating from 498 verified reviews, every implant decision is backed by both experience and evidence.
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