In the context of cemented hip arthroplasty, the Barrack-Harris grading of cement mantle quality grades the cement technique. A Grade B cement mantle is defined as:

• A Complete cement fill with no visible radiolucency at any zone — 'white-out' technique
• B Radiolucency at the cement-bone interface involving <50% of the cement mantle in one zone (Grade C) or multiple zones (Grade D)
• C Complete radiolucency between cement and bone throughout the stem but with cortical contact
• D Near-complete fill with a slight radiolucency at the cement-bone interface in <50% of one zone ✓

Explanation

The Barrack grading of cement mantle quality: Grade A ('white-out') = complete cement fill of the medullary canal with no visible radiolucency — optimal. Grade B = near-complete fill with slight radiolucency at the cement-bone interface affecting <50% of one zone. Grade C = radiolucency at the cement-cortex interface involving at least 50% of one zone, or a definite radiolucency in all zones. Grade D = radiolucency involving >50% of the cement mantle or failure to obtain distal cancellous interdigitation. Grade A and B are clinically acceptable; Grade C and D are associated with significantly higher loosening rates.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.