But I like doing uncemented...

The title of one of the worst films ever to achieve fame is the same as one of the best papers I've read in the last few years. It's in Bone & Joint 360, and it takes a careful, evidence based and pragmatic look at the use of uncemented total hip replacement in the NHS. It's not particularly pretty reading.

Put simply, it's not possible for uncemented hips to achieve better survivorship than the Charnley or Exeter, partly for statistical reasons (you could never have a study with adequate statistical power, unless we all start living to be 130). There is no evidence of better function - unlike, say, the much maligned resurfacings. There is evidence of higher complication rates - pain, leg length discrepancy, dislocation, periprosthetic fracture. Generally speaking they cost more. There is no consistent evidence that because you can in theory do them more quickly, you'll do more on a list. Not in the NHS anyway.

So why do them at all? Obviously they're great for many revisions, and there are specific cases - awkward anatomy, femoral shortening, the very young - where they make sense. There are quite a few uncemented stems with great survivorship, although not better than the cemented rivals.

If they're not being done for clinical reasons, or because they're cheaper, then it must be because the surgeon says so. Not ideal really. The UK still has a predominance of cemented stems, because of hybrids, but the commonest single combination is uncemented, albeit it's coming down slightly. Bizarre. Here's the NJR data:

And here's the Inconvenient Truth, followed by a short film on how to put them in: