Cemented vs. Cementless Hip Implant Fixation: How Surgeons Choose
A practical comparison of cemented and cementless (biological) fixation in total hip arthroplasty — indications, bone quality considerations, and how porous 3D-printed surfaces changed the equation.
Every total hip arthroplasty (THA) involves a fundamental fixation decision: anchor the implant with bone cement, or rely on biological fixation where bone grows onto and into the implant surface. Both strategies have decades of registry evidence behind them, and modern portfolios — including AK Medical's — deliberately include both.
Cemented fixation
Polymethylmethacrylate (PMMA) bone cement acts as a grout between implant and bone, providing immediate mechanical stability.
Typically favored when:
- Bone quality is poor (osteoporosis, elderly patients)
- Immediate full weight-bearing is a priority
- The femoral canal shape makes press-fit fixation unreliable
Devices such as the CPII cemented femoral stem, with polished taper-slip designs, represent this philosophy.
Cementless (biological) fixation
Cementless implants achieve initial stability through press-fit geometry, then long-term stability as bone integrates with the implant surface.
Typically favored when:
- Bone stock is good (younger, active patients)
- Long-term biological fixation is prioritized
- Future revision considerations favor preserving cement-free bone
This is where 3D-printed porous surfaces changed the equation. Traditional cementless implants used sprayed or sintered coatings; additive manufacturing builds the porous structure as part of the implant itself, with interconnected pores sized for bone ingrowth. AK Medical's 3DACT™ acetabular cups and augments are printed this way, and JRI Orthopaedics' Supravit™ hydroxyapatite VPS coating adds a bioactive surface chemistry with over 50 years of clinical heritage.
Hybrid strategies
Many surgeons mix approaches — for example, a cementless porous cup with a cemented stem in an elderly patient. Registry data across national joint registries show excellent survivorship for both fixation modes when matched to the right patient.
Key takeaways
- Neither fixation mode is universally superior; patient bone quality and age drive the choice
- 3D-printed trabecular surfaces have substantially improved cementless fixation reliability, especially in acetabular revision
- A complete implant portfolio should offer both — which is why AK Medical manufactures cemented stems, cementless stems, and 3D-printed porous cups within one system
Explore the hip cup system and femoral stem system in the product catalogue.
This article is for general education and is not medical advice. Treatment decisions should always be made with a qualified orthopedic surgeon.