title: Revision of the cemented femoral stem using a cement-in-cement technique: a five- to 15-year review.
abstract: The removal of well-fixed bone cement from the femoral canal during revision of a total hip replacement (THR) can be difficult and risks the loss of excessive bone stock and perforation or fracture of the femoral shaft. Retaining the cement mantle is attractive, yet the technique of cement-in-cement revision is not widely practised. We have used this procedure at our hospital since 1989. The stems were removed to gain a better exposure for acetabular revision, to alter version or leg length, or for component incompatibility. We studied 136 hips in 134 patients and followed them up for a mean of eight years (5 to 15). A further revision was required in 35 hips (25.7%), for acetabular loosening in 26 (19.1%), sepsis in four, instability in three, femoral fracture in one and stem fracture in one. No femoral stem needed to be re-revised for aseptic loosening. A cement-in-cement revision of the femoral stem is a reliable technique in the medium term. It also reduces the risk of perforation or fracture of the femoral shaft.
authors.affiliation: Princess Elizabeth Orthopaedic Centre, Royal Devon & Exeter Hospital, Exeter, England.
authors.forename: W W
authors.initials: WW
authors.lastname: Duncan
authors.forename: M J W
authors.initials: MJ
authors.lastname: Hubble
authors.forename: J R
authors.initials: JR
authors.lastname: Howell
authors.forename: S L
authors.initials: SL
authors.lastname: Whitehouse
authors.forename: A J
authors.initials: AJ
authors.lastname: Timperley
authors.forename: G A
authors.initials: GA
authors.lastname: Gie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D001843:Bone Cements / Q000627:therapeutic use*; D002484:Cementation / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005269:Femur / Q000601:surgery; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000601:surgery; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation / Q000379:methods; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements