Cement-within-cement revision of infected total hip replacement; disappointing results in 10 retrospective cases

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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.


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).


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.


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.

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