CEMENT-IN-CEMENT REVISIONS FOR ACUTE PERIPROSTHETIC INFECTION AFTER PRIMARY CEMENTED TOTAL HIP ARTHROPLASTY: A RETROSPECTIVE COHORT STUDY

Aim This study aimed to evaluate the effectiveness and applicability of two-stage cement-in-cement revision for treating acute periprosthetic joint infections (PJI) following primary cemented total hip arthroplasty (THA). Method We conducted a retrospective cohort study, with recurrence of PJI within two years after cement-in-cement revision as the primary outcome measure. Patients who underwent two-stage cement-in-cement femoral revisions for acute PJI (early postoperative or late haematogenous) between 2010 and 2022 were included. Patient demographics, treatment details, operative characteristics, infection parameters, and radiographic outcomes (assessed using Gruen zones) were collected and analyzed. Results Nine patients with acute PJI after primary THA underwent two-stage cement-in-cement femoral component revision. Five cases involved early postoperative PJI, and four involved late acute haematogenous PJI. Seven patients underwent one or two previous failed DAIR (Debridement, Antibiotics, and Implant Retention) procedures prior to revision surgery. All revisions incorporated impaction bone grafting of the acetabulum. At two years post-revision, all patients remained infection-free without the need for additional surgery or prolonged antibiotic therapy. The median follow-up duration was 46 months (IQR: 16–122 months). Radiographic follow-up revealed no osteolysis around the retained cement mantle. No prosthesis required re-revision within the two-year follow-up period. Conclusions Two-stage cement-in-cement femoral revision appears to be a safe and effective salvage treatment for acute PJI in primary cemented THA, for example after failed DAIR procedures. This revision technique offers excellent long-term infection control and ensures stable postoperative component fixation.