Four-angle radiographic assessment of cement mantle thickness in cemented total hip arthroplasty

In this study, the cement mantle thickness of 57 hips undergoing primary cemented total hip arthroplasty (THA) were investigated with 4 angle radiographs. All surgeries were performed with a standardized posterolateral surgical approach. In addition to conventional anteroposterior and lateral radiographs, obturator oblique and iliac oblique radiographs were taken. In the evaluation of the cementing grade on the anteroposterior radiograph, the incidence of hips with thin cement mantles was 25%. In evaluating the cementing grade on the anteroposterior and lateral radiographs, we found an incidence of hips with thin cement mantles of 37%. From the evaluations with 4 angle radiographs, 10 hips were additionally assigned as being of a poor cementing grade (Mulroy’s grade C-2). Thin cement mantles were mainly seen on the iliac oblique radiographs.