The Role of Cement in Femoral Component Revision
The joint replacement literature is replete with data supporting the use of in-growth stems, such as fully porous-coated or tapered stems, for revision total hip arthroplasty (THA) procedures.
Given the reported excellent survivorship data, why would an orthopaedic surgeon consider cementing the femoral stem in a revision procedure?
Because in some situations, cement is the better option, according to Michael P. Bolognesi, MD, from Duke University Medical Center, Durham, North Carolina.
Granted, cementing the stem is not the primary technique in contemporary revision THA. But there are indications for it, Dr. Bolognesi said in a presentation at ICJR’s Revision Hip & Knee Course, including:
- Older patients with minimal bone loss or large femoral canals
- An intact cement mantle (cement in cement technique)
- Avoiding morbidity related to cement removal
- Restoration of bone stock
In his presentation, Dr. Bolognesi summarizes the literature on the use of cemented femoral components, some of which shows good results – and some of which does not. Technique and use of appropriate components seem to be the key factors in success.
Dr. Bolognesi concluded that cement still has a role in selected revision cases, but this role is limited due to the success of stems that achieve distal fixation.
The literature shows that cement in cement technique and impaction grafting can be successful, but the surgeon needs to understand how to do them before considering them as options for revision THA patients.
In addition, the surgeon must take into consideration the patient’s bone quality, the age of the patient, the state of the cement mantle, and the availability of other treatment options that may be more viable.
Click the image below to watch Dr. Bolognesi’s presentation.