Cement-Within-Cement Revision Hip Arthroplasty; Should It Be Done?

Abstract

T he complete removal of the cement mantle at revision arthroplasty can be extremely difficult. Some authors advise a 'cement-within-cement' revision technique in which a new layer of cement is applied to the old before insertion of the femoral component. We could find no long-term clinical data regarding the success of this procedure. In a simple biomechanical study, we examined the strength of the cement-to-cement interface in conditions likely to prevail in vivo. We found that the presence of a thin layer of blood and marrow debris at the interface weakened the cement-to-cement bond by 80% to 85%. These biomechanical findings and additional photomicrographic evidence do not support the practice of cement-within-cement revision arthroplasty.

Femoral cement within cement technique in carefully selected aseptic revision arthroplasties

“…2a, b), acetabular failures in which the surgery is easier if the femoral component is taken out, conversion from a cemented hemiarthroplasty to a THA and recurrent dislocation (Fig. 3a, b) [17,18,20,22].…”

“…From a biomechanical viewpoint, this technique was validated by studies reported by Greenwald et al [12]. Although the method is about to turn 20 years old, the results of the cement within cement (CWC) technique have been described in the literature by few authors [17,18,20,22].…”

Revision total hip arthroplasty: the femoral side using cemented implants

“…This enables the surgeon to alter stem offset, version and the depth of insertion, which allow the stem to be adjusted for maximum stability and appropriate leg length at the time of acetabular revision. Concern has been expressed in the past about the durability of this technique [3]; however, our findings agree with those of others, all of whom have recorded good results with durable fixation and a low failure rate in the short/ medium term [4,20]. In the light of these favourable results the original indications for this procedure have now been expanded to include the treatment of Vancouver B2 periprosthetic fractures in cases where the cement bone interface is well fixed and the fracture reducible with encouraging short-to mid-term results.…”

“…It was suggested that rasping the surface of the existing cement mantle helped to clean the surface and possibly expose residual activator/ monomer in addition to providing a surface for improved mechanical interlock. Although this practice has been questioned in the orthopaedic literature, further biomechanical and clinical studies have supported the use of this technique in appropriate circumstances [3][4][5][6]. Lieberman et al reported a series of 19 patients with no femoral stem loosening at a mean follow-up of five years [4].…”

Revision Hip Arthroplasty: Management of Bone Loss

“…This technique has been questioned by other authors [96], but subsequent biomechanical and clinical studies have favored its use in properly selected cases [35,67,97]. In a cadaver study, Rosenstein et al demonstrated that cut strength at the cement-cement interface was greater than the strength at the cement bone interface [133].…”