Cement-in-cement revision of the cemented femoral stem as a treatment for periprosthetic fracture around a total hip arthroplasty: an up-to-date review.

Abstract

Periprosthetic fracture is a devastating complication of total hip arthroplasty that is associated with significant morbidity and mortality. Cement-in-cement revision of the femoral component is a technique that has been proposed as an efficient revision technique to treat femoral periprosthetic fractures where the femoral stem is loose, but the bone-cement interface is intact. By eliminating the need to remove the existing cement mantle, proposed advantages include shorter operative time, reduced blood loss, easy restoration of pre-fracture version and soft tissue tension, and eliminating the risk of iatrogenic damage from cement removal. However, the technique has not been widely popularised due to concerns over the fixation stability and risk of non-union from cement extrusion into the fracture site. Herein, an up-to-date review of the indications for, surgical technique of, and outcomes of cement-in-cement revision of the femoral component of a total hip arthroplasty for periprosthetic fracture is provided.