Apply the proximal seal and pressurize the cement.
A positive sign of pressurization is marrow extrusion in the greater trochanter (the so-called sweating trochanter sign).
As with the acetabulum, maintain pressure until the cement is sufficiently doughy to withstand bleeding. The time varies depending on type of cement used.
Apply the distal centralizer to the stem. The centralizer should be used to avoid malposition of the stem in both planes.
Introduction of the stem
Gently introduce the stem and hold in place until the cement has polymerized.
Even cement mantle
With the stem in final position, you should have a 2 - 3 mm cement mantle around the stem and approximately 10 mm between the tip of the stem and the plug.
This will yield optimal stress distribution.
Finally, reduce the hip.