Anterior or posterior: does the surgical approach to the hip influence the quality of the femoral cement mantle?

The purpose of this study was to determine whether the surgical approach to the femoral neck during total hip arthroplasty affects the quality of femoral cement mantle in terms of thickness and defects, both of which have been implicated in the development of aseptic loosening. A retrospective radiological review of 50 Stanmore Hip femoral stems inserted using the anterior approach and 50 inserted via the posterior approach was performed, with analysis by zone of cement mantle thickness and number of defects. This study demonstrates that the anterior approa ch is associated with an increase in the frequency of deficiencies in the cement mantle. We recommend that surgeons using the anterior approach are wary of this increased risk and adopt measures, such as the use of distal centralisers, to minimise its occurrence.