Cement-in-cement revision of the femoral stem: ANALYSIS OF 1179 FIRST-TIME REVISIONS IN THE SWEDISH HIP ARTHROPLASTY REGISTER

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Abstract

Aims

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.

Patients and 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.

Conclusion

The cement-in-cement technique for revision of the femoral component gave promising results using both designs of stem, six years post-operatively.

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