During total hip arthroplasty, the intraoperative cementation pressure was measured inside one of the acetabular anchorage holes. Patients were randomized to pressurization of cement with either a conventional pressurizer or a sequential method including individual pressurization of each anchorage hole. The pressure was correlated to the cement penetration measured on digital radiographs. The early peak pressures were higher for the sequential method, resulting in a significantly better penetration of 2.8 mm compared with 0.7 mm with the conventional pressurizer. We found a strong correlation between early peak cementation pressures and cement penetration into the cancellous bone of the anchoring holes, indicating a cause-effect relationship at this early stage. The highest peak pressures were achieved during the later cup insertion, but these pressures did not correlate with the cement penetration. We conclude that conventional methods for cement pressurization in the acetabulum may not be optimal. © 2004 Elsevier Inc. All rights reserved.