What is the correct sequence of steps for cementing a femoral stem in a cemented hip arthroplasty?

• A. Canal broach; select stem size; prepare canal; mix and pressurize cement; insert stem with proper alignment; verify fixation and stability; remove cement mantle around distal.
• B. Canal broach; mix and pressurize cement; select stem size; prepare canal; insert stem with proper alignment; verify fixation and stability; remove cement mantle around distal.
• C. Prepare canal; canal broach; select stem size; mix and pressurize cement; insert stem with proper alignment; verify fixation and stability; remove cement mantle around distal.
• D. Canal broach; select stem size; prepare canal; insert stem with proper alignment; mix and pressurize cement; verify fixation and stability; remove cement mantle around distal.

Answer: (A)

The essential idea is to sequence steps so that sizing, canal preparation, cementing, stem seating, and final cleaning produce a stable, well-fixed femoral component. First, use the canal broach to determine the appropriate stem size because sizing depends on the broached canal geometry and guides the subsequent steps. After selecting the size, prepare the canal to create a clean, roughened bed that promotes cement interdigitation. With the canal prepared, mix the bone cement and pressurize it into the canal to achieve good penetration and a uniform mantle before seating the stem. Then insert the stem with proper alignment while the cement is still workable to ensure stable fixation. After seating, verify fixation and stability to confirm there is no excessive movement or malalignment. Finally, remove or trim the cement mantle around the distal end to avoid distal cement extravasation or impingement and to reduce wear or loosening risks.