Mid-Term Outcomes of Cement-In-Cement Revision for Aseptic Loosening Versus Infection: A Comparative Study in a Small...

The cement-in-cement technique, which preserves the original cement mantle, has become a widely used surgical method in hip revision surgeries due to its ability to significantly simplify the procedure. Currently, no studies have directly compared the mid-term outcomes of using the cement-in-cement technique in patients with aseptic loosening vs those undergoing 1-stage revisions due to infection. We report the clinical and radiological outcomes of cement-in-cement femoral revisions performed for aseptic loosening and infection of hip.

We identified all patients undergoing cement-in-cement revision from January 2014 to October 2025. All cases were performed by the senior author using the Exeter Stem (Stryker Orthopaedics, Mahwah, New Jersey). Patients were followed-up annually with clinical and radiological assessment including survival rate, Oxford Hip Score and Western Ontario and McMaster Universities Osteoarthritis Index scores, quality of cementation and component subsidence.

A total of 13 patients matched the inclusion criteria (8 aseptic loosening and 5 infection). Mean follow-up was 3.5 years. A significant improvement in Oxford Hip Score and Western Ontario and McMaster Universities Osteoarthritis Index scores was observed in both groups ((P < .001). No difference was found between the 2 groups in functional and radiological assessment. One patient in the aseptic loosening group underwent further operation for infection. No femoral components were revised for aseptic loosening in both groups.

The cement-in-cement technique may be a reasonable option for single-stage revision for infection when the existing cement mantle is intact, providing bone preservation and outcomes comparable to aseptic revisions.