Cement-in-cement revision hip arthroplasty: an analysis of clinical and biomechanical literature.

INTRODUCTION: The number of revision hip arthroplasties is increasing but several aspects of this procedure could be improved. One method of reducing intra-operative complications is the cement-in-cement technique. This procedure entails cementing a smaller femoral prosthesis into the existing stable cement mantle. The aim of this systematic review is to provide a concise overview of the existing historical, operative, biomechanical and clinical literature on the cement-in-cement construct.
RESULTS: Four biomechanical publications exist in authoritative journals and these were reviewed. Simple specimens were produced and these were tested by static means. Although these published tests support the cement-in-cement technique, they cannot be regarded as conclusive. Areas which could be subject to further research are identified. Five clinical publications on patients undergoing cement-in-cement revisions were also reviewed. Patient numbers were generally low (7-53) apart from one study containing 354 patients. Long-term patient follow-up was not available except in Hubble's study (41 patients followed for 8 years). Outcomes of these patients were very satisfactory for the period of follow-up. Three expert reviews of cemented femoral revisions outline the cement in cement procedure. If other Orthopaedic Centres can emulate the results of the clinical research presented, complication rates, operative times and financial costs may be decreased.
CONCLUSION: The analysis presented in this paper consolidates the latest biomechanical and clinical information on cement-in-cement revision hip arthroplasty. Although we find evidence to support the use of the method clinically, we do note that the scientific basis needs further investigation.