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The cement-in-cement technique is a reliable option in hip arthroplasty revision surgery: a systematic review

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Abstract

Introduction

The cement-in-cement technique for revision hip arthroplasty has many potential advantages and has recently gained widespread interest but still lacks evidence to support it. Our aim was to examine the surgical and patient-reported outcomes after cement-in-cement revision hip arthroplasty.

Materials and methods

A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed and EMBASE databases were searched up to February 2019 for original studies reporting the outcomes of revision hip arthroplasty surgeries using the cement-in-cement technique. The methodological quality was assessed using the methodological index for non-randomized studies scale.

Results

Sixteen non-comparative studies met the eligibility criteria, comprising 1899 hips in 1856 patients (72.2 mean age, 37% male), with a mean follow-up of 7.2 years. Most studies reported only primary revisions and focused on the stem component. Intraoperative complications such as femoral or acetabular fractures (5.3%) were low and easily manageable with no relevant sequelae, as were dislocation rates (2.8% of uncomplicated events and 1.6% of cases requiring re-revision). Failure (considered if there was aseptic loosening of the cement-in-cement revised component, 2%), re-revision (9.3%), implant survival and late complication rates were favourable. Functional patient-reported outcomes showed an overall improvement above the minimal clinically important difference at final follow-up.

Conclusion

The cement-in-cement technique is a viable option for hip arthroplasty revision surgery with low intraoperative and late complication rates, dislocations and immediate post-operative morbidity, resulting in good functional patient-reported outcomes and favourable medium-term implant survival.

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. GRIP Unit, Orthopaedics Department, Centro Hospitalar e Universitário do Porto, Largo do Prof Abel Salazar, 4099-001, Porto, Portugal

    Francisco Xará-Leite, Ricardo Sousa & Daniel Soares

  2. Orthopaedics Department, Centro Hospitalar de Leiria, Leiria, Portugal

    Ana Daniela Pereira

  3. Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal

    Renato Andrade, André Sarmento & João Espregueira-Mendes

  4. Dom Henrique Research Centre, Porto, Portugal

    Renato Andrade & João Espregueira-Mendes

  5. Faculty of Sports, University of Porto, Porto, Portugal

    Renato Andrade

  6. Orthopaedics Department, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal

    André Sarmento

  7. Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada

    Olufemi R. Ayeni

  8. Orthopaedics Department, Minho University, Minho, Portugal

    João Espregueira-Mendes

  9. ICVS/3B’s–PT Government Associate Laboratory, Braga, Guimarães, Portugal

    João Espregueira-Mendes

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  1. Francisco Xará-Leite
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Contributions

FXL, ADP and RA performed the database searches, data analysis and initial interpretation of results. FXL was responsible for initial drafting of the article, assisted by RA and reviewed by all authors. RS, OA and DS provided advice throughout the interpretation of data and manuscript drafting. All authors were involved in the conception, design and interpretation of data. All authors read and reviewed the manuscript critically for important intellectual content and approved the final version to be submitted.

Corresponding author

Correspondence to Francisco Xará-Leite.

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Conflict of interest

André Sarmento is a consultant for Stryker Corporation, and is the current recipient of a teaching grant from the company. The authors declare they have no conflict of interest.

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Appendix

Appendix

See Tables 5, 6.

Table 5 Database search results up to 28th February 2019
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Table 6 Methodological index for non-randomized studies (MINORS) individual scoring
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Xará-Leite, F., Pereira, A.D., Andrade, R. et al. The cement-in-cement technique is a reliable option in hip arthroplasty revision surgery: a systematic review. Eur J Orthop Surg Traumatol 31, 7–22 (2021). https://doi.org/10.1007/s00590-020-02736-w

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