Revision of the cemented femoral stem using a cement-in-cement technique

Abstract

Retention of well-fixed bone cement at the time of revision THA is appealing, as its removal can be difficult and risks bone stock loss or fracture. The technique of cement in cement revision however is not in widespread use.

Femoral cement in cement revisions has been performed at our institution since 1989. Existing stems were removed to aid exposure for acetabular revision, alter version or leg length, or for component incompatibility.

Minimum follow up of 5 years was available for 136 cases (in 134 patients) with a mean of 8 years (maximum 15). 35 cases underwent further revision surgery (26 acetabular loosening, 4 sepsis, 3 instability, 1 femoral fracture and 1 stem fracture). No femoral stem has been re-revised for aseptic loosening.

These results support the technique of femoral cement in cement revision. Advantages include speed, less blood or bone stock loss and less risk of femoral perforation or fracture.