Removal and reinsertion of cemented femoral components during acetabular revision

Nabors, Eric D.; Liebelt, Ralph A.; Mattingly, D; Bierbaum, Benjamin E.

doi:10.1016/s0883-5403(05)80008-7

Cited by 45 publications

(19 citation statements)

References 9 publications

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“…4 Revision of the acetabular component is difficult and often requires wide exposure of the acetabulum if the femoral component is left in place. In such cases, trochanteric osteotomy or extensive soft-tissue mobilisation with anterior or posterior translation of the proximal femur are often considered.…”

Section: Revision Using a Cement-in-cement Technique Allows Increasedmentioning

confidence: 99%

Clinical and radiological evaluation of revision hip arthroplasty using the cement-in-cement technique

Goto

Kawanabe

Akiyama

et al. 2008

The Journal of Bone and Joint Surgery. British volume

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We reviewed 44 consecutive revision hip replacements in 38 patients performed using the cement-in-cement technique. All were performed for acetabular loosening in the presence of a well-fixed femoral component. The mean follow-up was 5.1 years (2 to 10.1). Radiological analysis at final follow-up indicated no loosening of the femoral component, except for one case with a continuous radiolucent line in all zones and peri-prosthetic fracture which required further revision. Peri-operative complications included nine proximal femoral fractures (20.4%) and perforation of the proximal femur in one hip. In five hips wiring or fixation with a braided suture was undertaken but no additional augmentation was required. There was an improvement in the mean Japanese Orthopaedic Association score from 55.5 (28 to 81) pre-operatively to 77.8 (40 to 95) at final follow-up (p < 0.001). Revision using a cement-in-cement technique allows increased exposure for acetabular revision and is effective in the medium term. Further follow-up is required to assess the long-term results in the light of in vitro studies which have questioned the quality of the cement-in-cement bond.

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Section: Revision Using a Cement-in-cement Technique Allows Increasedmentioning

confidence: 99%

Clinical and radiological evaluation of revision hip arthroplasty using the cement-in-cement technique

Goto

Kawanabe

Akiyama

et al. 2008

The Journal of Bone and Joint Surgery. British volume

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“…1,3 There is a risk of femoral fracture 2,4 and creating excess bone loss, adding to the operating time which has the potential to increase infection rates, thrombosis and general anaesthetic complications. In a well fixed cement mantle, several centres have published data on the technique of a cement-in-cement revision, whereby the original cement mantle is maintained and a new, smaller stem is cemented into the old mantle.…”

Section: Discussionmentioning

confidence: 99%

“…Removing the cement mantle requires time and patience with a risk of further bone damage and possible fracture. [1][2][3][4] Retention of the old cement mantle and insertion of a smaller or shorter stem -the cement-in-cement revisiondescribed for taper stems -provides a good alternative if the cement mantle is stable, but is limited if a smaller size or offset stem is already in situ. We present a newly described technique, the ''In-cement'' revision -the introduction of a stem, the same size as the original implant, into the previous cement mantle, without additional cement or downsizing.…”

Section: Introductionmentioning

confidence: 99%

A valuable technique for femoral stem revision in total hip replacement: The in-cement revision – A case series and technical note

McDougall

Calligeros

et al. 2016

Journal of Orthopaedics

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A valuable technique for femoral stem revision in total hip replacement: The in-cement revision -A case series and technical note IntroductionRevision of a cemented femoral stem can be a challenging procedure. Removing the cement mantle requires time and patience with a risk of further bone damage and possible fracture.1-4 Retention of the old cement mantle and insertion of a smaller or shorter stem -the cement-in-cement revisiondescribed for taper stems -provides a good alternative if the cement mantle is stable, but is limited if a smaller size or offset stem is already in situ. We present a newly described technique, the ''In-cement'' revision -the introduction of a stem, the same size as the original implant, into the previous cement mantle, without additional cement or downsizing. This has not been previously described or investigated in the literature. We present the technique and a series of 23 cases. In-cement revision requires an intact and stable cement mantle in the correct version. The benefits include improved view of the acetabulum, time efficiency, the ability to use the same size stem and utilisation of the previous distal centralised spacer plug to facilitate subsidence. TechniqueAfter either general or spinal anaesthetic, the patient is positioned laterally. An incision is made through the previous scar and the hip is exposed through a posterior approach. After appropriate dissection and debridement, the hip is dislocated, the head tapped off and the cemented, polished, tapered stem is removed (Fig. 1).There are three primary keys in the technique:1. Inspection of the cement mantle for stability and version (Fig. 2).Inspect the cement mantle for cracks and coverage. Forceps or a pituitary rongeur are used to attempt to mobilise the cement and therefore determine if it is stable. Version is assessed and is deemed either appropriate or not appropriate. If the version of the previous stem is not appropriate or the cement mantle is not stable, an in-cement revision should not be pursued. 2. Protection of the cement mantle (Fig. 3).Place a moist swab in the canal to prevent debris from the acetabular revision dropping into the cement mantle.The acetabulum is then exposed and revised as appropriate. 3. Reinsertion of the same size stem without a centraliser (Fig. 4).No centraliser is used to facilitate subsidence. Tap in the stem until it re-engages with the taper. Double check the length of the Revision of a cemented femoral stem can be a challenging procedure. We present a series of cases utilising the ''In-cement'' revision, whereby the same size stem is introduced into the original cement mantle, without additional cementing. It requires a stable cement mantle in the correct version.We describe the technique and present a review of 23 revision total hip replacements performed over a 5 year period. At average follow-up of 67 months (12-128 months), the overall survivorship was 91.3% with no patient requiring re-revision for stem loosening or mechanical failure. Two patients required rerevision for...

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“…Several reports have described a technique in which a well-fixed cemented femoral component is removed and then reinserted into its cement mantle following acetabular revision [2,17]. Only a cemented femoral component with minimal curvature and without a textured or precoated surface can be removed without destroying the cement mantle.…”

Section: Discussionmentioning

confidence: 99%

Isolated acetabular revision after total hip arthroplasty: results at 5–9 years of follow-up

Chen

Waddell

Morton

et al. 2005

International Orthopaedics (SICOT)

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The purpose of the study was to determine whether isolated revision of the acetabular component can be successfully performed without disturbing the femoral stem and to determine the fate of the unrevised femoral stem following revision. Fifty-seven hips in 55 patients underwent isolated acetabular revision without removal of the femoral component. Thirty-three hips with minimal acetabular deficiency required no bone grafting; the remaining 24 hips were treated by morselized or structural allograft in addition to a new acetabular component. Twenty-two of these 24 hips demonstrated incorporation of the bone graft. A mean follow-up of 5.8 (5-9) years, all femoral and acetabular components were judged to be stable and well fixed.Résumé Le but de l'étude est de déterminer si la révision isolé du composant acétabulaire peut être exécutée avec succès sans déranger la tige fémorale et, deuxièmement, de déterminer l'avenir de la tige fémorale laissée en place, après cette révision. Cinquante-sept hanches chez cinquante-cinq malades ont subi une révision acétabulaire isolée sans ablation du composant fémoral. Trente-trois hanches avec une déficience acétabulaire minime n'ont exigé aucune greffe osseuse; les 24 hanches restantes ont été traitées par une allogreffe morcelée ou structurelle associée à un nouveau composant acétabulaire. Vingt-deux de ces 24 hanches ont montré une incorporation de la greffe d'os. A un suivi moyen de 5,8 ans (5 à 9 ans) tout les composants fémoraux et acétabulaires ont été jugés stables et bien fixés.

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Removal and reinsertion of cemented femoral components during acetabular revision

Cited by 45 publications

References 9 publications

Clinical and radiological evaluation of revision hip arthroplasty using the cement-in-cement technique

Clinical and radiological evaluation of revision hip arthroplasty using the cement-in-cement technique

A valuable technique for femoral stem revision in total hip replacement: The in-cement revision – A case series and technical note

Isolated acetabular revision after total hip arthroplasty: results at 5–9 years of follow-up

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