PARTIAL RETENTION OF THE ACETABULAR CEMENT MANTLE IN REVISION HIP ARTHROPLASTY: IS IT A REASONABLE OPTION?

Although cement in cement acetabular revision is a recognised option in the presence of a well-fixed cement mantle, partial cement mantle retention is not normally recommended or practiced. However, when revising a cemented acetabular cup it is not infrequent to be faced with loose superolateral cement but well-fixed medial cement. Removal of the well-fixed cement can be time consuming and destructive. An alternative would be to retain this cement and incorporate it into the reconstruction. This study assesses the practice and results of partial cement mantle retention (PCR) at acetabular revision. We retrospectively identified a cohort of 28 hips in 26 patients using the PCR technique from 1 st January 2000 to 1 st January 2013. This represented 3.3% of cup revisions where a cemented cup was used. The area of cement loss was reconstructed in one of three ways: re-cementing into drill holes (6 cases); impaction grafting of the defect (8 cases); or use of a trabecular metal wedge (14 cases). 24 hips had a minimum 2-year follow up (mean 6 years). There were no subsequent revisions for aseptic loosening. One acetabulum was later revised for dislocation and X-rays were lost in one patient leaving 22 patients with x-ray available and retained implants. Two of these cases showed progression of lucent lines, which were not clinically significant. Retaining well-fixed medial cement during socket revision appears to be a reasonable reconstruction option in carefully selected cases.