The cement-in-cement femoral revision is a possible method of reducing complications. During recent research on this revision it was observed that a number of the inner cement contained macropores. It was hypothesized that porosity of the mantle influenced the subsidence and inducible displacement of the revision stems. The aim was to calculate the porosity and assess its relationship to the above factors.

Primary cement mantles were formed by cementing a stem into sections of tubular steel. At this stage, the specimen was chosen to be in a test or a control group. If in the test group, it underwent a fatigue of 1 million cycles. This was carried out in a fatigue machine mounted with a specifically designed rig. If in the control group, no such fatigue was undertaken. Into these fatigued and unfatigued mantles, the cement-in-cement procedure was performed. Both groups underwent a fatigue of again 1 million cycles. Subsidence and inducible displacement was recorded. The composites were then sectioned and photographed. The images underwent image analysis to calculate the porosity.

Multiple regression and a general linear model showed subsidence was inversely correlated to the porosity of the “fresh cement” in Gruen zones 3 and 5 (p = 0.021, R2 = 0.36). This relationship was not expected. The reason could be related to the fact that the migration of the stems in each separate direction was not monitored. Inducible displacement was inversely correlated to porosity of the inner cement, again in Gruen zones 3 and 5 (p = 0.001, R2 = 0.61). A possible explanation is that the stem was able to subside more due to the higher porosity and find a more stable position.

The subsidence and inducible displacement of these stems is influenced by porosity, specifically by the porosity of the distal inner cement.

One method of reducing intra-operative complications in revision hip surgery is the cement-in-cement technique. Some concern exists regarding the retention of the existing fatigued cement mantle. It was hypothesised that leaving the existing fatigued cement mantle does not degrade the mechanical properties of the cement in cement revision construct. The aim of this research was to test this hypothesis using in vitro fatigue testing of analogue cement in cement constructs.

Primary cement mantles were formed by cementing a large polished stem into sections of tubular stainless steel using polymethylmethacrylate with Gentamicin. At this stage, the specimen was chosen to be in the test group or the control group. If in the test group, it underwent a fatigue of 1 million cycles. This was carried out in a specifically designed rig and a fatigue testing machine. Into these fatigued and unfatigued primary mantles, the cement in cement procedure was carried out. Both groups underwent a fatigue of again 1 million cycles. Subsidence of the stems and their inducible displacement was recorded. A power calculation preceded testing.

Completion of a Mann Whitney test on the endpoints of the subsidence curves revealed that there is no statistical difference between the data sets (means 0.51, 0.46, n=10 + 10, p = 0.496). This data was also calculated for the inducible displacement. Again, there was no statistical difference in the separate groups for this parameter (means 0.38, 0.36, p = 0.96). This methodology produces a complex 3 dimensional reconstruction of the cement in cement revision which replicates the in vivo structure. This reconstruction has undergone fatigue testing. Neither of these two aspects has been produced for the study of cement in cement revision before.

A fatigued primary cement mantle does not appear to degrade the mechanical properties of the cement in cement revision construct