title: Cement-within-cement revision of infected total hip replacement; disappointing results in 10 retrospective cases.
abstract: BACKGROUND
  This retrospective analysis evaluates 10 patients with a late infection of a cemented total hip arthroplasty (THA) treated with two-stage revision with retention of the original well-fixed femoral cement mantle.
  
  
  METHODS
  Clinical, laboratory, and radiological outcomes were evaluated. The average age at the first-stage revision procedure was 61.5 years (range 38-80 y). The mean follow-up period was 26 months (range 5-54 m).
  
  
  RESULTS
  Successful eradication of the primary microorganism was achieved in 2 patients. These patients had negative cultures at second stage and did not show any signs of infection during follow-up.The other 8 patients were considered as failures. In 3 patients, the femoral cement mantle was removed after the first stage due to recurrent infection in Girdlestone situation. In 2 patients, cultures showed the same micro-organism at first and second stage, treated with 3 months of antibiotics after second stage. 2 patients showed negative cultures at second stage but still had recurrent infection afterwards. These where treated with debridement and implant retention (DAIR) and 3 months of antibiotics. 1 patient was treated with suppressive antibiotics for persistent prosthetic joint infection after second stage, despite DAIR and therapeutic antibiotic treatment.
  
  
  CONCLUSIONS
  Based on this study, results of two-stage revision with retention of femoral cement mantle are disappointing in treatment of infected THA. Therefore, more research is required to determine which patients are appropriate for cement-within-cement revision.
authors.affiliation: Department of Orthopaedic Surgery, Radboud University Medical Centre, Nijmegen - The Netherlands.
authors.forename: Borg
authors.initials: B
authors.lastname: Leijtens
authors.affiliation: Department of Orthopaedic Surgery, Radboud University Medical Centre, Nijmegen - The Netherlands.
authors.forename: Nasrat
authors.initials: N
authors.lastname: Sadeghi
authors.affiliation: Department of Orthopaedic Surgery, Radboud University Medical Centre, Nijmegen - The Netherlands.
authors.forename: Berend W
authors.initials: BW
authors.lastname: Schreurs
authors.affiliation: Department of Orthopaedic Surgery, Radboud University Medical Centre, Nijmegen - The Netherlands.
authors.forename: Wim H
authors.initials: WH
authors.lastname: Rijnen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000295:instrumentation*; D002484:Cementation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery*; D011475:Prosthesis Failure / Q000009:adverse effects; D016459:Prosthesis-Related Infections / Q000601:surgery*; D012086:Reoperation / Q000009:adverse effects*; D012189:Retrospective Studies; D016896:Treatment Outcome