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Scientists comment on a shortage of ‘bone cement’ disrupting NHS joint operations.
Dr Alex Dickinson, Professor of Prosthetics Engineering, University of Southampton, said:
What is the medical cement and what procedures is it used for?
“’Bone cement’ is the commonly used term for this family of PMMA-based polymers which are mixed during orthopaedic surgery. Bone cement is most commonly used to fix joint replacement implants (primarily knee or hip replacements, for people with osteoarthritis) to the bone. It works like a grout, rather than a glue, and sometimes it includes antibiotics to avoid or fight infection. Bone cement was one of the major developments in joint replacement technology pioneered by Sir John Charnley, which contributed to the highly successful surgeries we have today.
“Bone cement is not used for all joint replacements – ‘un-cemented’ or ‘cementless’ implants, often used for younger people, have a rough surface with coatings made from titanium and other materials like hydroxyapatite (HA) which is similar to the mineral part of bone. Cementless fixation is achieved initially by friction and a press-fit, and the recovery from surgery involves the bone growing into the rough surface, forming a ‘biological fixation’ with the implant. However, in older patients the cemented fixation option is usually preferred because it fixes the implant immediately.”
How many people might be affected by this?
“In 2025 our ‘National Joint Registry’ NJR 22nd Annual Report 2025.pdf [1] reported that in 2024 we had over 134,000 knee procedures and over 90% of ‘primary’ (i.e. first-time) procedures were all-cemented.
“From the same source, just under 117,000 primary hip procedures were reported in 2024, and around 59% were all-cemented or ‘hybrid’ (one component cemented, the other un-cemented).”
Are there any other alternative materials that could be used?
“There are other manufacturers of bone cement, but there is not an alternative material that could just be substituted. We have a relatively small number of implant structural materials, bearing materials and fixations, which have good performance according to the registry data. Implant engineering at its best is a very cautious and gradual process. Any new technology potentially carries risks to the patient, and we must go through very thorough development work to try and minimise these risks. It also takes years of follow-up to see the long-term outcomes of new technologies.”
References:
[1] https://reports.njrcentre.org.uk/Portals/0/PDFdownloads/NJR%2022nd%20Annual%20Report%202025.pdf
Dr Wayne Nishio, Senior Lecturer in Biomaterials at the School of Dentistry, Cardiff University, said:
What is the medical cement and what is procedures is it used for?
“Bone cement is widely used in joint replacement surgeries (e.g. hip and knee replacements) as a grouting material to secure metal implants to bone. Antibiotics can also be incorporated into the cement to prevent and treat joint replacement infections. Bone cement is more commonly used for knee replacements than hip replacements in the UK (around 83% of knee replacements use bone cement, versus 14% for hip replacements). Between 2003 and 2024 (last 20 years), around 2 million hip and knee surgeries used bone cement (469,572 hip and 1,494,853 knee – data from National Joint Registry 2025 report – https://reports.njrcentre.org.uk/). Generally, bone cement is favoured for elderly patients or complex cases as their ability to grow bone around a metal implant is impaired.
Why is there a current shortage?
“It’s not entirely clear, however it appears that there has been a manufacturing issue within Heraeus, one of the global providers of Palacos bone cement.”
How many people might be affected by this?
“It’s hard to predict this but in the UK in 2024 alone, around 126,000 patients had knee and hip surgeries requiring bone cement (16,833 hip, 109,606 knee – data from National Joint Registry). If the two-month delay is correct, we can expect somewhere in the region of 20,000 patients being affected.
Are there any other alternative materials that could be used?
“Alternative materials would not be appropriate as they haven’t been tested for this specific application and may not perform to the required standards. For any material to be marketed and used as a medical device in patients in the UK, regulatory approval would be required from the Medicines and Healthcare products Regulatory Agency (MHRA), which is an extremely lengthy and slow process (taking years). The quickest solution would be to procure bone cements from other companies as there are many competing manufacturers of this product (e.g. Stryker, Zimmer-Biomet, Smith & Nephew, Johnson & Johnson, Tecres). I think this highlights an issue with NHS procurement processes, which results in an overreliance on one supplier, potentially impacting thousands of patients when things go wrong.
When might expect it to be resolved?
“The manufacturer states around two months delay, however the longer-term impact is significant as hospitals are already struggling to catch up with the huge waiting lists for joint replacements.”
Any other relevant information
“Most commercial bone cement formulations are very similar and have not really changed drastically since they were first invented by Sir John Charnley in the late 1950s. In our Biomaterials Research Group lab we have made bone cements from the basic ingredients that have similar composition and performance to those currently on the market. The challenge is getting approval to use these formulations as an emergency product and setting up a scalable and GMP/ISO13485 compliant manufacturing line.”
Fergal Monsell, President of the British Orthopaedic Association, said:
“The BOA is working with NHS Supply Chain, NHS England and the relevant Specialist Orthopaedic Societies to identify possible alternative supplies and evidence-based practice to reduce the impact on patients. This is a situation that is beyond the control of trauma and orthopaedic surgeons and NHS organisations.
“The solutions we are recommending are designed to lessen the impact on patients and will be determined on the basis of safety and identified clinical need.
“NHS trusts have also been advised to utilise the released theatre time to treat orthopaedic patients where procedures do not require the use of cement.
“The BOA will update surgeons with developments so they can treat their patients as the situation develops.”
Declared interests
Dr Wayne Nishio: “I collaborated with Zimmer Biomet (a competing bone cement manufacturer) on an EPSRC-funded research project between March 2021 to December 2023 and I have a patented bone cement technology.”
For all other experts, no reply to our request for DOIs was received.