Purpose: There is evidence that recommends the retention of a well-fixed cement mantle at the time of revision hip arthroplasty. The cement-cement interface has been proven to have a greater shear strength than a new bone-cement interface after removing the old cement mantle.

Method: This study reviewed a series of acetabular revision procedures with a minimum 2-year follow-up where the original cement mantle was left intact. From 1988 to 2004, 63 consecutive cement-in-cement revisions of the acetabular component were performed at our institution. Outcome was based on functional assessment using the Oxford, Charnley, and Harris scoring systems as well as radiographic analysis using the DeLee and Charnley criteria.

Results: In total 63 procedures were performed in 61 patients (40 female and 21 male), whose mean age at surgery was 74 years (range 40 to 99 years). 47 hips (75%) were performed for recurrent dislocation, 13 for aseptic loosening, 1 for pain, 1 for excessive shortening, and 1 for disarticulation of a constrained liner. No case was lost to follow-up. There was a significant improvement in the functional scores from the pre-operative status with the patients maintaining a low level of pain. There was one re-revision for aseptic cup loosening at 7 years, with 1 further case of radiological loosening identified at the latest review. There were 6 further cases of dislocation 5 of which were treated with further in-cement revisions. All other cases showed well-fixed components on radiographic analysis and no evidence of failure at the most recent follow up.

Conclusion: The cement-in-cement revision technique can be used in selected cases of acetabular revision surgery, providing satisfactory functional outcomes backed up by good radiographic results. Blood loss and surgical time are also significantly decreased.