. Author manuscript; available in PMC: 2023 Feb 27.

Published in final edited form as: J Bone Joint Surg Am. 2022 Mar 17;104(11):1024–1033. doi: 10.2106/JBJS.21.00853

TABLE III.

Summary of Prior Cementing Techniques

Generation	Description

First^21,23,63	Originated in the 1960s No osseous preparation, such as washing Cement inserted in antegrade fashion using finger packing, which led to inadequate penetration of cement into cancellous bone, inclusion of blood in cement, and poor cement mantle
Second^62,65	Canal preparation through cleaning to remove blood and fat Cement restrictor Cement inserted using gun in retrograde fashion Improved penetration into bone resulted in decreased risk of femoral component loosening
Third⁶⁶	Added the use of vacuum mixing to reduce porosity of cement Also focused on maintaining pressurization before and during insertion of femoral prosthesis
Fourth	Femoral canal preparation using a brush, followed by pulsatile lavage Canal packing with gauze soaked in hemostatic solution Vacuum cement mixing Retrograde cement introduction using long-nozzle cement gun, use of distal cement restrictor Maintaining cement pressurization