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    Cement-in-cement revision of the femur in infected hip arthroplasty in 89 patients across two centres

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    URI
    https://rde.dspace-express.com/handle/11287/622420
    Author
    Fishley, W. G.
    Selvaratnam, V.
    Whitehouse, S. L.
    Kassam, A. M.
    Petheram, T. G.
    Date
    2022-02-01
    Journal
    The bone & joint journal
    Type
    Journal Article
    Publisher
    British Editorial Society of Bone and Joint Journal
    DOI
    10.1302/0301-620x.104b2.Bjj-2021-0598.R1
    Rights
    © 2022 The British Editorial Society of Bone & Joint Surgery
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    Abstract
    AIMS: Femoral cement-in-cement revision is a well described technique to reduce morbidity and complications in hip revision surgery. Traditional techniques for septic revision of hip arthroplasty necessitate removal of all bone cement from the femur. In our two centres, we have been using a cement-in-cement technique, leaving the distal femoral bone cement in selected patients for septic hip revision surgery, both for single and the first of two-stage revision procedures. A prerequisite for adoption of this technique is that the surgeon considers the cement mantle to be intimately fixed to bone without an intervening membrane between cement and host bone. We aim to report our experience for this technique. METHODS: We have analyzed patients undergoing this cement-in-cement technique for femoral revision in infection, and present a consecutive series of 89 patients. Follow-up was undertaken at a mean of 56.5 months (24.0 to 134.7) for the surviving cases. RESULTS: Seven patients (7.9%) required further revision for infection. Ten patients died of causes unrelated to their infection before their two-year review (mean 5.9 months; 0.9 to 18.6). One patient was lost to follow-up at five months after surgery, and two patients died of causes unrelated to their hip shortly after their two-year review was due without attending. Of the remaining patients, 69 remained infection-free at final review. Radiological review confirms the mechanical success of the procedure as previously described in aseptic revision, and postoperative Oxford Hip Scores suggest satisfactory functional outcomes. CONCLUSION: In conclusion, we found that retaining a well-fixed femoral cement mantle in the presence of infection and undertaking a cement-in-cement revision was successful in 82 of the patients (92.1%) in our series of 89, both in terms of eradication of infection and component fixation. These results are comparable to other more invasive techniques and offer significant potential benefits to the patient. Cite this article: Bone Joint J 2022;104-B(2):212-220.
    Citation
    Bone Joint J. 2022 Feb;104-B(2):212-220. doi: 10.1302/0301-620X.104B2.BJJ-2021-0598.R1.
    Publisher URL
    https://online.boneandjoint.org.uk/doi/10.1302/0301-620X.104B2.BJJ-2021-0598.R1?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
    Note
    Not held
    Collections
    • 2022 Eastern publications
    • Exeter Hip Unit

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    • CEMENT-IN-CEMENT REVISION OF THE FEMUR IN THE INFECTED HIP ARTHROPLASTY 

      W, Fishley; V, Selvaratnam; I, Carluke; P, Partington; M, Reed; D, Kramer; M, Wilson; M, Hubble; J, Howell; A, Timperley; S, Whitehouse; AA, Kassam; T, Petheram (British Editorial Society of Bone and Joint Journal, 2021-08-19)
      Femoral cement-in-cement revision is a well described technique to reduce morbidity and complications in hip revision surgery. Traditional techniques for septic revision necessitate removal of all bone cement from the ...
    • Cement-in-cement femoral component revision in the multiply revised total hip arthroplasty: results with a minimum follow-up of five years. 

      Sandiford, N A; Jameson, S S; Wilson, Matthew J.; Hubble, Matthew J.; Timperley, Andrew J.; Howell, Jonathan R. (British Editorial Society of Bone and Joint Journal, 2017-02)
      We present the clinical and radiological results at a minimum follow-up of five years for patients who have undergone multiple cement-in-cement revisions of their femoral component at revision total hip arthroplasty (THA).
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      Cnudde, P H J; Kärrholm, J; Rolfson, O; Timperley, John; Mohaddes, M (Bone and Joint Society, 2017-04)
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