During cemented hip arthroplasty, what is a key objective when inserting the femoral stem?

• A. Insert with proper alignment.
• B. Insert as rapidly as possible.
• C. Ensure maximum cement mantle distally.
• D. Avoid any contact with bone.

Answer: (A)

Aligning the femoral stem with the femoral canal is crucial because the way the stem sits sets how forces are transmitted through the cement mantle into the bone. When the stem is correctly aligned, with neutral rotation and proper varus/valgus positioning, it preserves leg length and offset, promotes even load distribution, and minimizes micromotion at the cement-bone interface. This stability reduces the risks of loosening, subsidence, abnormal wear, and dislocation, improving the long-term success of the cemented fixation.

Inserting as quickly as possible can compromise precise positioning and damage the cement mantle or bone. Focusing on maximizing cement mantle distally isn’t the primary goal—what matters most is a well-seated, correctly aligned stem that achieves stable fixation. Avoiding contact with bone isn’t appropriate because a proper cemented stem relies on a good cement-bone interface and appropriate contact to transfer loads effectively.