Purpose: Removal of all foreign material is the normal practice at the time of revision arthroplasty for sepsis. However, removal of well-fixed bone cement is time consuming, can result in significant bone stock loss and increases the risk of femoral shaft perforation or fracture. We have performed two-stage revision for infection in a series of cases in which we have left oseeointegrated femoral cement at the first stage and we present the results of this technique.

Method: All patients underwent two-stage revision for infection. At the first stage the prostheses and acetabu-lar cement were removed but when the femoral cement mantle demonstrated good osseo-integration it was left in-situ. Following Girdlestone excision arthroplasty (GEA), patients received local antibiotics delivered by cement spacers, as well as systemic antibiotics. At the second stage the existing cement mantle was reamed, washed and dried and then a femoral component was cemented into the old mantle.

Results: Sixteen patients (M:F 5:11) had at least three years follow up (mean 80 months, range 43 to 91). One patient died of an unrelated cause at 53 months. Recurrence of infection was not suspected in this case. The mean time to first stage revision was 57 months (3 to 155). The mean time between first and second stages was 9 months (1 to 35). Organisms were identified in 14 (87.5%) cases (5 Staphylococcus Aureas, 4 Group B Streptococcus, 2 Coagulase negative Staphylococcus, 2 Enterococcus Faecalis, 1 Escheria Coli). At second stage, five (31.2%) acetabuli were uncemented and 11 (68.8%) were cemented. There were two complications; one patient dislocated 41 days post-operatively and a second patient required an acetabular revision at 44 days for sudden loss of fixation. No evidence of infection was found at re-revision. One patient has been revised for recurrent infection. Currently no patients are suspected of having a recurrence of infection.

Conclusion: Retention of a well-fixed femoral cement mantle during two-stage revision for infection and subsequent in-cement reconstruction is safe with a cure rate of 93%. Advantages include a shorter operating time, reduced loss of bone stock, improved component fixation and a technically easier second stage procedure.