EXPERIENTIAL RADIOLOGICAL OUTCOMES OF FEMORAL REVISION USING CEMENT-WITHIN-CEMENT TECHNIQUE

Abstract

At the revision surgery of the cemented Total hip arthroplasty (THA), complete removal of an old cement mantle of the femur without loosening is very difficult. It can be associated with complications, such as femoral fracture, perforation and femoral bone loss. Cement-within-cement technique (CWCT) of femoral revision is very useful and advantageous without those complications for special cases.

We reviewed the experiential radiological outcomes using CWCT for the cemented femoral revision.

Between 1999 and 2006, we performed seventeen of revision THA using CWCT in 17 patients.

There were four men and 13 women, with an average age of 75 years (range 68 to 87), with an average follow up of 39 months (range 12 to 87).

The reasons for revision surgery were eleven for cup loosening, 5 for recurrent dislocation and one technical failure of stem insertion intra-operatively.

An original Charnley stem (Depuy, Leeds, England) was implanted in six cases, an Exeter femoral component (Stryker Benoist Girard, Herouville, Saint-Clair, France) was in 10 and another stem in one.

Posterolateral approach without trochanteric osteotmy was performing for all patients. After the femoral component was removed, the cement mantle was examined in detail, to confirm cement-bone interface and cement fracture.

The cement mantle was washed with a pulsatile lavage to clean and to be dried.

If necessary, the surface of the cement mantle was reamed. A double mix of Simplex P cement (Stryker Limerick, Limerick, Ireland) in liquid phase was inserted within the cement mantle by a cement gun with a thin nozzle(Stryker Instruments Kalamazoo, US). Thereafter suction and pressuriser were used, and a femoral component was inserted.

The results of this study were that the intra-operative complication was two fractures of the greater trochanter at the stem removed and was one shaft perforation at a new original Charnley stem inserted. The stem position was one valgus and 3 varus stem position of more than 2 degrees.

Radiographic outcomes showed no stem loosening, no radiolucent line at the bone-cement interface, nor any osteolysis in the patients at final follow-up.

We conclude that this cement-within-cement technique is good radiographic outcomes up to 87 months and this technique should be used with the thinner femoral component than the previous.