TABLE V.

Steps for Femoral Preparation and Cemented Stem Insertion^*

Step	Description
Anesthetic considerations	Notify the anesthesia team approximately 20 minutes before cementing to allow for FiO2 increase and fluid resuscitation and to make vasopressors available
Femoral preparation	Large rongeur used to remove medullary contents from lateral femoral neck Curved canal finder rasp used to enter femoral canal Flexible reamer used to sound femoral canal Broach with increasingly sized femoral broaches to templated and/or appropriate size Trial reduction to confirm appropriately sized/positioned implants Irrigate and suction femoral canal Place cement restrictor Place whistle-tip suction catheter in base of femoral canal; pack ribbon gauze into canal Place gauze in acetabulum
Cementing and pressurization	Cement is ready to be inserted when it can be easily molded in surgeon’s hand without adhering to the glove Remove ribbon gauze; keep suction catheter in place Fill canal in retrograde fashion with cement gun with long nozzle Use finger to hold pressure over cement and remove suction catheter Remove long cement nozzle and place foam nozzle on cement gun and replace over canal Apply firm pulses of pressure for 30–60 seconds and observe for fat and marrow contents extruding from cortex
Stem insertion	Insert stem by hand with long hand attachment, with thumb holding pressure over medial calcar Advance stem to two-thirds of its length into canal and remove excess cement; check position Advance stem to final depth and remove excess cement; do not alter final position while cement cures

^*FiO₂ = fraction of inspired oxygen.