Cement-in-cement revision of the femoral stem: analysis of 1179 first-time revisions in the Swedish Hip Arthroplasty Register.

AIMS: Compared with primary total hip arthroplasty (THA), revision surgery can be challenging. The cement-in-cement femoral revision technique involves removing a femoral component from a well-fixed femoral cement mantle and cementing a new stem into the original mantle. This technique is widely used and when carried out for the correct indications, is fast, relatively inexpensive and carries a reduced short-term risk for the patient compared with the alternative of removing well-fixed cement. We report the outcomes of this procedure when two commonly used femoral stems are used. PATIENTS AND METHODS: We identified 1179 cement-in-cement stem revisions involving an Exeter or a Lubinus stem reported to the Swedish Hip Arthroplasty Register (SHAR) between January 1999 and December 2015. Kaplan-Meier survival analysis was performed. RESULTS: Survivorship is reported up to six years and was better in the Exeter group (91% standard deviation (sd) 2.8% versus 85% sd 5.0%) (p = 0.02). There was, however, no significant difference in the survival of the stem and risk of re-revision for any reason (p = 0.58) and for aseptic loosening (p = 0.97), between revisions in which the Exeter stem (94% sd 2.2%; 98% sd 1.6%) was used compared with those in which the Lubinus stem (95% sd 3.2%; 98% sd 2.2%) was used. The database did not allow identification of whether a further revision was indicated for loosening of the acetabular or femoral component or both. CONCLUSION: The cement-in-cement technique for revision of the femoral component gave promising results using both designs of stem, six years post-operatively. Cite this article: Bone Joint J 2017;99-B(4 Supple B):27-32.

Union rates and midterm results after Extended Trochanteric Osteotomy in Revision Hip Arthroplasty. Useful and safe technique.

Aim of this study was to evaluate the outcome fol-lowing extended trochanteric osteotomy in series of single surgeon, with emphasis on complications and union of osteotomy. Retrospective Case Series of all patients who had revision total hip replacement surgery performed by senior author between 2003 and 2012, with follow up between 1 and 10 years. 108 cases of revision hip arthroplasty with use of Extended Trochanteric Osteotomy were evaluated. In 101 cases solid bony union was achieved. In 7 cases where the bony union was not established, an asymptomatic and stable position was achieved. In 12 cases greater trochanter fracture was noted postoperatively with proximal migration 5 to 15mm. 1 patient required surgery to re-attach greater trochanter. Extended Trochanteric Osteotomy is a safe and very useful technique that can be used in revision hip surgery.