During surgery, once the hip joint is exposed, the head and neck of the femur are removed. The shaft of the femur is then reamed to accept the metal component consisting of the head, neck, and stem. The acetabulum is then reamed to accept a plastic cup. The ball and socket are then replaced into normal position. Both of these implants can be fastened into the bone with or without special cement.

• Cemented procedure. The cemented procedure utilizes a doughy substance mixed at the time of surgery that is introduced between the artificial component and the bone. This type of fixation in total hips remains the gold standard and is the method of choice for many surgeons. Depending upon their health and bone density, people over the age of 60 will receive this type of joint fixation.



• Noncemented procedure. Despite its common use, not all individuals are candidates for a cemented hip. Studies show that young active adults tend to loosen their artificial components prematurely. The current trend therefore, is to use an artificial joint covered with a material that allows bone tissue to grow into the metal. A tight bond of scar tissue if formed, which anchors the metal to the bone. This is called a cementless total hip replacement.

This type of surgery is technically more sensitive, requiring a more exact fit of the metal component to the femur. In this procedure, the surface of the metal is prepared with a small porous roughened coat, which attracts bone in growth. This process is called porous ingrowth or oseointegration.

In general, the artificial joint implants used in the non-cemented procedure are larger than those used with cement but are still proportional to the size of the individual bone. Since their introduction, many different devices using cementless fixation have been used with the hope that these implants will maintain their attachment to bone for a longer period of time.