Cement-in-cement revision of the

femur in infected hip arthroplasty:

89 patients across two centres

with a minimum 5 year follow up

MP Graya,b, WG Fishleya, M Clarka, P Partingtona, T Oswalda, AM Kassamb, TG Petherama

a. Northumbria Revision Arthroplasty Group, Northumbria Healthcare NHS Trust, UK

b. Exeter Hip Unit, Princess Elizabeth Orthopaedic Centre, Exeter, UK

Background & Aims

Traditional techniques for septic revision of hip arthroplasty

necessitate removal of all bone cement from the femur.

Femoral cement-in-cement (CinC) revision surgery is a welldescribed

alternative technique for aseptic revision1, reducing

morbidity & complications compared with traditional techniques.

Strict criteria for technique adoption must be met (as previously

described2), utilising orthogonal radiographs and intraoperative

assessment to deem a cement mantle to be well-fixed to bone.

Inadequately fixed cement is removed until well-fixed cement

without an intervening cement-bone membrane is reached. Often

cement above the level of the lesser trochanter is thus removed.

In such cases, we utilise a CinC technique for both single and the

first stage of two-stage procedures across our 2 centres.

Building on our early experience2, we report the medium-term

outcomes at a minimum of 5 years for our series of 89 patients.

Results

• Median age at index operation was 74.

• Seven patients (7.9%) required further revision for

infection at 2 years. Of note, no additional revisions

for infection were observed beyond 2 years.

• 2 aseptic reoperations for other reasons were

observed (1 revision for a broken stem, 1

periprosthetic fracture).

• In keeping with the demographics of this cohort and

the wider PJI literature, a total of 45 patients died of

causes unrelated to their infection at latest follow up.

• Of the remaining patients, 37 were infection-free at

their final review.

• Radiological review confirms mechanical success of

the procedure comparable to the aseptic revision

setting, with no cases of radiological failure.

• Postoperative Oxford Hip Scores suggest satisfactory

functional outcomes.

Methods

Clinical, biochemical and radiological results for surviving cases in our

consecutive series of 89 patients across 2 centres were analysed.

Follow-up was at a mean of 8.2 years (5.1 to 13.7).

Conclusions

CinC revision in the presence of

infection and a well-fixed distal

femoral cement mantle was

successful in 82 of the patients

(92%) in our series of 89 patients at

minimum 5-year follow up.

No revisions for infection were

seen in this series beyond 2 years.

These results are comparable to

traditional, more invasive

techniques and offer a significant

potential patient benefit through

a reduction in surgical morbidity.