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Background and purpose Two contradictory cementing techniques (using an undersized stem versus a canal-filling stem) can both lead to excellent survival rates, a phenomenon known as the “French paradox”. Furthermore, previous studies have indicated that the type of bone supporting the cement mantle may affect implant survival. To further evaluate the mechanical consequences of variations in cementing technique, we studied the effect of implant size and type of bone supporting the cement mantle on the mechanical performance of cemented total hip arthroplasty, using finite element analysis.

Methods In a generic 2-dimensional plane-strain finite element model of a transverse section of a cemented total hip arthroplasty with a Charnley-Kerboull stem, we varied implant size and type of bone supporting the cement mantle. The models were subjected to 2 × 10⁶ cycles of an alternating loading pattern of torque …