title: Cement-in-cement revision of the femoral stem: analysis of 1179 first-time revisions in the Swedish Hip Arthroplasty Register.
abstract: OBJECTIVE
  Compared with primary total hip arthroplasty (THA), revision surgery can be challenging. The cement-in-cement femoral revision technique involves removing a femoral component from a well-fixed femoral cement mantle and cementing a new stem into the original mantle. This technique is widely used and when carried out for the correct indications, is fast, relatively inexpensive and carries a reduced short-term risk for the patient compared with the alternative of removing well-fixed cement. We report the outcomes of this procedure when two commonly used femoral stems are used.
  
  
  METHODS
  We identified 1179 cement-in-cement stem revisions involving an Exeter or a Lubinus stem reported to the Swedish Hip Arthroplasty Register (SHAR) between January 1999 and December 2015. Kaplan-Meier survival analysis was performed.
  
  
  RESULTS
  Survivorship is reported up to six years and was better in the Exeter group (91% standard deviation (sd) 2.8%versus85% sd 5.0%) (p = 0.02). There was, however, no significant difference in the survival of the stem and risk of re-revision for any reason (p = 0.58) and for aseptic loosening (p = 0.97), between revisions in which the Exeter stem (94% sd 2.2%; 98% sd 1.6%) was used compared with those in which the Lubinus stem (95% sd 3.2%; 98% sd 2.2%) was used. The database did not allow identification of whether a further revision was indicated for loosening of the acetabular or femoral component or both.
  
  
  CONCLUSIONS
  The cement-in-cement technique for revision of the femoral component gave promising results using both designs of stem, six years post-operatively. Cite this article:Bone Joint J2017;99-B(4 Supple B):27-32.
authors.affiliation: Swedish Hip Arthroplasty Register, Registercentrum Västra Götaland, SE 413 45 Gothenburg, Sweden.
authors.forename: P H J
authors.initials: PH
authors.lastname: Cnudde
authors.affiliation: Swedish Hip Arthroplasty Register, Registercentrum Västra Götaland, SE 413 45 Gothenburg, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Kärrholm
authors.affiliation: Swedish Hip Arthroplasty Register, Registercentrum Västra Götaland, SE 413 45 Gothenburg, Sweden.
authors.forename: O
authors.initials: O
authors.lastname: Rolfson
authors.affiliation: Royal Devon and Exeter NHS Foundation Trust, Hip Unit, Princess Elizabeth Orthopaedic Centre, Barrack Road, Exeter, EX2 5DW, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Timperley
authors.affiliation: Swedish Hip Arthroplasty Register, Registercentrum Västra Götaland, SE 413 45 Gothenburg, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Mohaddes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D001843:Bone Cements; D002484:Cementation / Q000379:methods*; D020878:Device Removal / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006622:Hip Prosthesis; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012042:Registries; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data; D013548:Sweden; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements
keywords: Cement-in-cement; Femur; Joint register; Re-revision; Revision hip arthroplasty