Abstract
Introduction
Stem revision with retention of the old cement mantle (cement-in-cement revision) in cases with an intact cement/bone interface is an appealing option. There has been an increasing use of this technique. In 2014 this cement-in- cement technique was used in 10% of all stem revisions reported to the Swedish Hip Arthroplasty Register (SHAR). We analysed the outcome of cement-in-cement stem revisions reported to the SHAR during years 2001–2014
Patients/Materials & Methods
Since 2001 1292 cement-in-cement revisions (study group), performed with a short (≤150 mm) Exeter stem (n=973) or a Lubinus stem (n=319) were reported to the SHAR. Stem revisions, using short Exeter and Lubinus stems without the use of the cement-in-cement technique (n=2893) acted as the control group in this analysis. Both groups were comparable regarding primary diagnosis. In the study group there were more females and the mean age (73 years) was 2 year older (p<0.001). The primary outcome was re-revision due to all causes (n=413). Re-revision of the stem due to all causes, infections excluded (n=212) was used as secondary outcome. Survival analysis using Kaplan-Meier was performed.
Results
Survival with re-revision due to all causes at 8 years in the cement-in-cement group (85±3%) was comparable to the control group (84±2%) (p=0.73). The survival of the stem with re-revision due to aseptic loosening at 8 years did not differ between the groups (92±3% and 91±1% respectively) (p=0.52).
Discussion
Cement-in-cement revisions had a re-revision rate of the same magnitude as in revisions where the cement mantle was extracted. In this later group more severe bone defects may be present.
Conclusion
We believe that cement-in-cement revision with a shorter operation time and less preoperative complications could be an attractive option in cases with intact cement/bone interface.
