Cemented, Uncemented and Hybrid Fixation in THR

Part of The Joint Replacement Guide — Phase 4: The Operation · Article 21 of 42 · Hip

Key Points

• There are three main ways a hip replacement can be anchored to your bone: cemented, uncemented, and hybrid.
• The right choice depends on your bone quality, age, and activity level, alongside surgeon judgement and experience.
• UK national data has specifically informed guidance around fixation choice by age group.
• All three approaches have strong long-term track records when used appropriately.

Cemented Fixation

Cemented fixation uses a bone cement (PMMA) to anchor the implant securely to your bone at the time of surgery — this is the technique pioneered by Sir John Charnley and described in the earlier article on the history of hip replacement. It has the longest and most well-established track record of any fixation method, with excellent long-term survivorship in national registry data, and is particularly favoured in older patients, whose bone is often softer and less predictable for reliable uncemented fixation.

Uncemented (Press-Fit) Fixation

Uncemented implants have a specially textured or porous surface designed to encourage your own bone to grow onto, and in some designs into, the implant over the following weeks and months — a process called osseointegration — creating a strong biological fixation without cement. This avoids certain cement-related considerations, but relies on good quality bone to achieve reliable initial stability while that bone ingrowth takes place, which is why it is more commonly used in younger, more active patients with good bone quality.

Hybrid Fixation

Hybrid fixation combines both approaches, typically using a cemented femoral stem alongside an uncemented acetabular cup (the socket component), aiming to draw on the particular strengths of each method for the two different parts of the joint. This is a well-established and widely used option, particularly where a surgeon judges that one bone (the femur or the pelvis) is better suited to one fixation type than the other.

What the Evidence and Registries Say

UK national registry and GIRFT data has specifically highlighted differences in outcomes by age group and fixation type — in particular, uncemented fixation in certain older or more frail patient groups has, in some UK data, been associated with a higher risk of complications such as periprosthetic fracture (a fracture around the implant), which has informed national guidance favouring cemented fixation in older patients. Uncemented fixation, by contrast, continues to be well supported by good long-term outcomes in younger patients with good bone quality. Ultimately, the decision is individualised, taking into account your age, activity level, bone quality — sometimes assessed formally through bone density scanning — and your surgeon’s own experience and judgement.

In More Depth

The biological process behind uncemented fixation — osseointegration — typically takes several weeks to a few months to achieve strong fixation, which is part of why initial mechanical stability of the implant at the time of surgery is so important for this technique to succeed; if the implant is not sufficiently stable from the outset, bone cannot grow onto it effectively. Modern cementing technique has also improved considerably since Charnley’s era, including methods such as pulsed lavage (thorough washing of the bone surface before cementing) and pressurisation of the cement, both of which improve the quality and durability of the cement bond compared with earlier techniques.

This article is general information and does not replace individual clinical advice.

Sources

• National Joint Registry — Annual Report, fixation type and survivorship data
• GIRFT (Getting It Right First Time) — National Report on Orthopaedics
• British Hip Society — fixation guidance

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