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Occlusion and stability of synthetic femoral canal plugs used in cemented hip arthroplasty.

The occlusion and stability of five synthetic plugs used to restrict the femoral canal prior to cemented arthroplasty was assessed. A model was employed consisting of a hollow wooden dowel to simulate the canal, with adapters fixed to both ends to accommodate cement insertion and pressurization, and to produce a closed distal cavity. Three different canal diameters within the range accommodated by the plug selected were employed to assess insertion force, distal pressure during both insertion and pressurization of acrylic cement, and plug migration and leakage for each device. There was a wide variation among plugs in the magnitudes of the force and distal pressure upon plug insertion. During cement pressurization, cement leakage and/or plug migration was noted in all trials, and either of these events resulted in pressure rises in the distal cavity. Most notably, differences of only 0.5 mm in the diameter of the canal resulted in marked changes in the occlusion and stability achieved. It is concluded that for the range of canal sizes anticipated intraoperatively, these synthetic plugs appear deficient to varying extents in their ability to occlude or remain stable in the intramedullary canal.