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Ann R Coll Surg Engl. 2009 May; 91(4): 346–347.
PMCID: PMC2749412
Technical Notes and Tips
Bruce Campbell, Section Editor

A Novel Introducer for the Hardinge Cement Restrictor Used in Cemented Total Elbow Arthroplasty

BACKGROUND

Contemporary cementing techniques aim to improve cement penetration into bone, resulting in increased initial fixation strength, a more enduring micro-interlock fixation and reduced failure by aseptic loosening.1 Intramedullary plugging is integral to this and in humeral preparation prevents cement migration towards the shoulder, which may hinder future surgery. Several humeral plugs have been described.24 The humeral canal lumen is, however, narrowest distally and insertion of an introducer can compromise this canal. We believe that the Hardinge Cement Restrictor (DePuy UK, Leeds, UK) is in popular use but have found the bulky size of the Hardinge introducer problematic.

TECHNIQUE

We describe a technique of introducing the Hardinge Cement Restrictor into the humeral canal on a readily available and cheap 2.0-mm threaded guide wire. The flanges of the restrictor are trimmed to the appropriate size then threaded onto the guide wire producing a secure construct for insertion (Fig. 1). Once inserted at the correct level, the wire is unscrewed and removed, leaving the restrictor in situ.

Figure 1
Hardinge Cement Restrictor on a 2-mm threaded guide wire.

DISCUSSION

The Hardinge Cement Restrictor is familiar to most orthopaedic surgeons and benefits from being on-hand in most orthopaedic units. However, the differences in humeral and femoral anatomy make the use of the Hardinge introducer a threat to the integrity of the bone. The use of a 2.0-mm threaded guide wire produces a sound, safe and accessible construct for the insertion of the cement restrictor. In our experience, migration of the restrictor has not been observed. Figure 2 demonstrates the device's efficacy.

Figure 2
Postoperative anteroposterior X-ray.

References

1. Mulroy RD, Harris WH. The effect of improved cementing techniques on component loosening in total hip replacement. An 11-year radiographic review. J Bone Joint Surg Br. 1990;72:757–60. [PubMed]
2. Zimmer.co.uk (homepage on the Internet) Coonrad/Morrey Total Elbow Surgical Technique. UK: Zimmer, Inc; [site updated 31 July 2008, technique updated 1 May 2005]. < http://www.zimmer.co.uk/web/enUS/pdf/surgical_techniques/Coonrad_Morrey_Surgical_TECHNIQUE_97-8106-102-00_Rev_1_05-2005.pdf>.
3. Faber KJ, Cordy ME, Milne AD, Chess DG, King GJW, Johnson JA. Advanced cement technique improves fixation in elbow arthroplasty. Clin Orthop. 1997;(334):150–6. [PubMed]
4. Danter MR, King GJW, Chess DG, Johnson JA, Faber KJ. The effect of cement restrictors on the occlusion of the humeral canal. J Arthroplasty. 2000;15:113–9. [PubMed]

Articles from Annals of The Royal College of Surgeons of England are provided here courtesy of The Royal College of Surgeons of England