The cement in cement technique for revision total hip arthroplasty (THA) has shown good results in selected cases. However, results of its use in the revision of hemiarthroplasty to THA has not been previously reported.

Between May 1994 and May 2007 28 (20 Thompson's and 8 Exeter bipolar) hip hemiarthroplasties were revised to THA in 28 patients using the cement in cement technique. All had an Exeter stem inserted at the time of revision. Clinical and operative data were collected prospectively. Clinical evaluation was by the Charnley, Harris and Oxford. Hip scores and radiographs were analysed post-operatively and at latest follow up.

The mean age at time of hemiarthroplasty revision was 80 (35 to 93) years. The reason for revision was acetabular erosion in 12 (43%), recurrent dislocation in eight (29%), aseptic stem loosening in four (14%), periprosthetic fracture in two (7%) and infection in a further two (7%) patients. No patient has been lost to follow up. Three patients died within three months of surgery. The mean follow up of the remainder was 50 (16 to 119) months. Survivorship with revision of the femoral stem for aseptic loosening as the endpoint was 100%. Three cases (11%) have since undergone further revision, one for recurrent dislocation, one for infection, and one for periprosthetic fracture.

The cement in cement technique can be successfully applied to revision of hip hemiarthroplasty to THA. It has a number of advantages in this elderly population including minimising bone loss, blood loss and operative time.

Removal of well-fixed cement at the time of revision THA for sepsis is time consuming and risks bone stock loss, femoral perforation or fracture. We report our experience of two-stage revision for infection in a series of cases in which we have retained well-fixed femoral cement.

All patients underwent two-stage revision for infection. At the first stage the prostheses and acetabular cement were removed but when the femoral cement mantle demonstrated good osseo-integration it was left in-situ. Following Girdlestone excision arthroplasty (GEA), patients received local antibiotics delivered by cement spacers, as well as systemic antibiotics. At the second stage the existing cement mantle was reamed, washed and dried and then a femoral component was cemented into the old mantle.

Sixteen patients (M:F 5:11) had at least three years follow-up (mean 80 months – range 43 to 91). One patient died of an unrelated cause at 53 months. Recurrence of infection was not suspected in this case. The mean time to first stage revision was 57 months (3 to 155). The mean time between first and second stages was nine months (1 to 35). Organisms were identified in 14 (87.5%) cases (5 Staphylococcus Aureas, 4 Group B Streptococcus, 2 Coagulase negative Staphylococcus, 2 Enterococcus Faecalis, 1 Escheria Coli). At second stage, five (31.2%) acetabulae were uncemented and 11 (68.8%) were cemented. There were two complications; one patient dislocated 41 days post-operatively and a second patient required an acetabular revision at 44 days for failure of fixation. No evidence of infection was found at re-revision. One patient (1/16, 7%) has been re-revised for recurrent infection. Currently no other patients are suspected of having a recurrence of infection (93%).

Retention of a well-fixed femoral cement mantle during two-stage revision for infection and subsequent cement-in-cement reconstruction appears safe with a success rate of 93%. Advantages include a shorter operating time, reduced loss of bone stock, improved component fixation and a technically easier second stage procedure.

Hind and mid foot arthritis is often noted in patients who have previously had an ankle arthrodesis. It has been suggested that this arthritis may be precipitated or exacerbated as a direct result of the ankle fusion. The aim of this study was to investigate the degree and pattern of pre-existing ipsilateral foot arthritis in patients who have subsequently undergone ankle arthrodesis.

A retrospective review of the most recent pre-operative radiographs of 70 patients who underwent 71 arthrodeses between 1993-2003 was performed. Patients with rheumatoid disease were excluded. The immediate pre-operative AP and lateral ankle radiographs were assessed and the presence and severity of osteoarthritis for the sub-talar, talo-navicular, naviculo-cuneiform and calcaneo-cuboid joints was recorded using the Kellgren and Lawrence grading score. This was performed simultaneously by two reviewers and a consensus obtained. A total score out of 16 was given for each radiograph.

68 (96%) of the radiographs reviewed showed evidence of pre-existing hind or mid foot arthritis prior to ankle fusion. The sub-talar joint was the most commonly and severely affected. The median total arthritis score for each radiograph was 5. There was no association between age or causative pathology and the degree of arthritis.

This study has demonstrated that hind and mid foot arthritis is very common in patients with co-existent ankle arthritis prior to ankle fusion. This has previously been assumed to have developed as a result of the surgery but is, in fact, present at the time of the operation and this needs to be taken into consideration when evaluating the results of ankle arthrodesis

Restoration of an anatomical hip centre frequently requires limb lengthening, which increases the risk of nerve injury in the treatment of Crowe 4 DDH. The objective was to perform a prospective evaluation of SDTSO with Cemented Exeter Femoral Component.

15 female patients (18 hips – 3 bilateral) with a mean age at time of operation of 51 years were followed-up for a mean of 77 months (11 to 133). 16 cemented and 2 uncemented acetabular components were implanted. Exeter cemented DDH stems were used in all cases. No patient was lost to follow-up.

Charnley-d'Aubigné-Postel scores for pain, function and range of movement were improved from a mean of 2, 2, 3 to 5, 4, 5 respectively. One osteotomy failed to unite at 14 months and was revised successfully. Clinical healing was achieved at a mean of 6 months and radiological at a mean of 9 months. The mean length of the excised segment was 3cm and the mean true limb lengthening was 2cm. A 3.5mm DCP plate with unicortical screws was used to reduce the osteotomy, and intramedullary autografting was performed in all cases. Mean subsidence was 1mm and no stem was found loose at the latest follow-up. No sciatic nerve palsy was observed and no dislocation.

Cemented Exeter femoral components perform well in the treatment of Crowe IV DDH with SDTSO. Transverse osteotomy is necessary to achieve derotation and reduction can be maintained with a DCP plate. Intramedullary autografting prevents cement interposition at the osteotomy site.

Aim

The aim of this study was to determine the medium term survivorship and function of the Exeter Universal Hip Replacement when used in younger patients, a group that is deemed to place high demands on their arthroplasties. Since 1988 The Exeter Hip Research Unit has prospectively gathered data on all patients who have had total hip replacements at the Princess Elizabeth Orthopaedic Hospital. There were 130 Exeter Universal total hip replacements (THR) in 107 patients who were 50 years or younger at the time of surgery and whose surgery was performed at least 10 years before. Mean age at surgery was 42 years (range 17-50 years.) Six patients who had 7 THRs had died, leaving 123 THRs for review. Patients were reviewed at an average of 12.5 years (range 10-17 years). No patient was lost to follow-up.

Purpose

We describe an update of our experience with the implantation of the first 325 Exeter Universal hips. The fate of every implant is known.

Purpose: Removal of all foreign material is the normal practice at the time of revision arthroplasty for sepsis. However, removal of well-fixed bone cement is time consuming, can result in significant bone stock loss and increases the risk of femoral shaft perforation or fracture. We have performed two-stage revision for infection in a series of cases in which we have left oseeointegrated femoral cement at the first stage and we present the results of this technique.

Method: All patients underwent two-stage revision for infection. At the first stage the prostheses and acetabu-lar cement were removed but when the femoral cement mantle demonstrated good osseo-integration it was left in-situ. Following Girdlestone excision arthroplasty (GEA), patients received local antibiotics delivered by cement spacers, as well as systemic antibiotics. At the second stage the existing cement mantle was reamed, washed and dried and then a femoral component was cemented into the old mantle.

Results: Sixteen patients (M:F 5:11) had at least three years follow up (mean 80 months, range 43 to 91). One patient died of an unrelated cause at 53 months. Recurrence of infection was not suspected in this case. The mean time to first stage revision was 57 months (3 to 155). The mean time between first and second stages was 9 months (1 to 35). Organisms were identified in 14 (87.5%) cases (5 Staphylococcus Aureas, 4 Group B Streptococcus, 2 Coagulase negative Staphylococcus, 2 Enterococcus Faecalis, 1 Escheria Coli). At second stage, five (31.2%) acetabuli were uncemented and 11 (68.8%) were cemented. There were two complications; one patient dislocated 41 days post-operatively and a second patient required an acetabular revision at 44 days for sudden loss of fixation. No evidence of infection was found at re-revision. One patient has been revised for recurrent infection. Currently no patients are suspected of having a recurrence of infection.

Conclusion: Retention of a well-fixed femoral cement mantle during two-stage revision for infection and subsequent in-cement reconstruction is safe with a cure rate of 93%. Advantages include a shorter operating time, reduced loss of bone stock, improved component fixation and a technically easier second stage procedure.

Periprosthetic fractures around a cemented femoral stem present a challenge to the treating surgeon. We propose a technique whereby a well fixed cement mantle can be retained in cases with simple fractures that can be reduced anatomically. This technique is well established in femoral stem revision, but not in association with a fracture.

24 Vancouver type B periprosthetic femoral fractures were treated by reducing the fracture and cementing a revision stem into the pre-existing cement mantle, with or without supplementary fixation.

3 patients died in the first 6 months for reasons not related to surgery and one was too frail to attend follow up. The remaining 20 cases were followed up for a mean of 3.0 years. The median time to radiological and clinical union was 3.0 months (2–11). The median Modified Harris Hip Score was 76.9 (35–97) and there was no sign of loosening or subsidence of the revision stems within the old cement mantle in any case at most recent follow up. One patient had further surgery for a delayed union and there were 2 subsequent fractures distal to the original fracture site in patients with poor bone stock.

Our results support the use of the cement-in-cement stem revision technique in anatomically reducible peri-prosthetic fractures with a well preserved pre-existing cement mantle. It is particularly suitable for older patients.

The cement in cement technique for revision total hip arthroplasty (THA) has shown good results in selected cases. However results of its use in the revision of hemiarthroplasty to THA has not been previously reported.

Between May 1994 and May 2007 28 (20 Thompson’s and 8 Exeter bipolar) hip hemiarthroplasties were revised to THA in 28 patients using the cement in cement technique. All had an Exeter stem inserted at the time of revision. Clinical and operative data were collected prospectively. Clinical evaluation was by the Charnley, Harris and Oxford hip scores and radiographs were analysed post-operatively and at latest follow up.

There is evidence that recommends the retention of a well-fixed cement mantle at the time of revision hip arthroplasty. The cement-cement interface has been proven to have greater shear strength than a new bone-cement interface after removing a well-fixed cement mantle. This study reviewed a series of acetabular revision procedures with a minimum 2-year follow-up where the original cement mantle was left intact. From 1988 to 2004, 60 consecutive cement-in-cement revisions of the acetabular component were performed at our institution. Outcome was based on functional assessment using the Oxford, Charnley, and Harris scoring systems as well as radiographic analysis using the DeLee and Charnley criteria.

In total 60 procedures were performed in 60 patients (40 female and 20 male), whose mean age at surgery was 75 years (range 40 to 99 years). 80% were performed for recurrent dislocation, 13.3% during femoral component revision, 5% for acetabular component wear, and 1.7% for pain. No case was lost to follow-up.

There was one re-revision for aseptic cup loosening at 7 years, with 1 further case of radiological loosening identified at the latest review. There were 6 further cases of dislocation 4 of which were treated with further in-cement revisions. All other cases showed well-fixed components on radiographic analysis and no evidence of failure at the most recent follow up.

The cement-in-cement technique already has a good body of evidence based on revision of the femoral component and this study shows that the technique can be applied to acetabular revisions as well with good functional and radiological results in the short to medium term.

Survivorship of the standard Exeter Universal cemented stem with revision of the femoral component for aseptic loosening as the endpoint has been reported as 100% at 12 years. A version for use in smaller femora, the Exeter 35.5 mm stem, was introduced in 1988. Although also a collarless polished taper, the stem is slimmer and 25 mm shorter than a standard stem.

Between August 1988 and August 2003 192 primary hip arthroplasties were performed in 165 patients using the Exeter 35.5 mm stem. Clinical and operative data were collected prospectively. Clinical evaluation was by the Charnley, Harris and Oxford hip scores and radiographs were analysed post-operatively and at latest follow up.

The review of the first 325 Exeter Universal hips reported good long term survivorship despite the majority of cups being metal backed. We have reviewed the long term performance of the concentric all-polyethylene Exeter cups used with the Universal Exeter stem.

Clinical and radiographic outcomes of 263 consecutive primary hip arthroplasties in 242 patients with mean age 66 years (range, 18 to 89) were reviewed. 118 cases subsequently died none of whom underwent a revision. Eighteen hips have been revised; thirteen for aseptic cup loosening, three for recurrent dislocation and two for deep infection. Three patients (four hips) were lost to follow-up. The minimum follow-up of the remaining 123 hips was 10 years (mean 13.3 years, range 10–17). Radiographs demonstrated 4 (4%) of the remaining acetabular prostheses were loose. The Kaplan Meier survivorship at 14.5 years with endpoint revision for all causes is 91.5% (95% CI 86.6 to 96.2%). With endpoint revision for aseptic cup loosening, survivorship is 93.3% (CI 88.8 to 97.8%).

This series included a number of complex cases requiring bone blocks and/or chip autograft for acetabular deficiencies. The concentric all polythene Exeter cup and Exeter stem has excellent long term results particularly when factoring in the complexity of cases in this series.

There is evidence that recommends the retention of a well-fixed cement mantle at the time of revision hip arthroplasty. The cement-cement interface has been proven to have a greater shear strength than a new bone-cement interface after removing the old cement mantle.

This study reviewed a series of acetabular revision procedures with a minimum 2 year follow-up where the original cement mantle was left intact. From 1988 to 2004, 61 consecutive cement-in-cement revisions of the acetabular component were performed at our institution. Outcome was based on functional assessment using the Oxford, Charnley, and Harris scoring systems as well as radiographic analysis using the DeLee and Charnley criteria.

In total 61 procedures were performed in 59 patients (40 female and 19 male), whose mean age at surgery was 75 years (range 40 to 99 years). 47 hips (77%) were performed for recurrent dislocation, 12 for polyethylene wear associated with other reasons for revision (aseptic stem loosening in 8, stem fracture in 2, femoral periprosthetic fracture in 1, subluxation in 1), 1 for unexplained pain, and 1 for disarticulation (intraprosthetic dislocation) of a constrained liner. No case was lost to follow-up. There was a significant improvement in the functional scores from the pre-operative status with the patients maintaining a low level of pain. There was one re-revision for aseptic cup loosening at 7 years, with 1 further case of radiological loosening identified at the latest review. There were 6 further cases of dislocation 4 of which were treated with further in-cement revisions. All other cases showed well-fixed components on radiographic analysis and no evidence of failure at the most recent follow up.

The cement-in-cement revision technique can be used in selected cases of acetabular revision surgery, providing satisfactory functional outcomes backed up by good radiographic results. Blood loss and surgical time are also significantly decreased.

Objectives: Retrospective case control study of management and outcome of periprosthetic femoral fractures, from the lower limb reconstruction unit in Exeter.

Material and Methods: 144 fractures over a period of 20 years were reviewed. The Vancouver classification system wasd used to clasify the fractures. The prosthesis length was measured pre and post-peratively. The use of impaction grafting technique for inadequate bone quality of the surrounding bone was assessed (type B3 fractures). The use of Dall/Miles, DCP and Mennen plates was also assessed. Healing was defined using radiological and clinical criteria and where available the Harris Hip Score. Chi-square test with p< 0.05 was used for the statistical analysis of the Results:

Results: When the Vancouver system was applied 2.85% of the fractures were classified as type A, 87.2% as type B and 10% as type C. Within the type B group 13.2% were subtype B1, 12% subtype B2 and 62% subtype B3. 1 out of 6 Mennen, 4 out of 16 Dall/Miles and 2 out of 20 DCP plates failed. Overall 68% healing, 5% non-union, 4% infection, 23% re-fracture rate at 12 months follow-up. Better healing was achieved when impaction grafting was used for B3 fractures (p=0.001). Better healing was achieved when the revision stem was bypassing the most distal fracture line by at least 2 ipsilateral femoral diameters and impaction grafting was used for B3 fractuires (p=0.01).

Conclusion: Impaction Grafting can compensate for the inadequate bone in type B3 fractures and appears to promote union. Revision stem should bypass the most distal fracture line by at least 2 cortical diameters to achieve healing.

20 Vancouver type B periprosthetic femoral fractures were treated in our unit by cementing a revision stem into the pre-existing cement mantle following fracture reduction. The technique was used in elderly, multiply co-morbid patients with the intention of reducing operative time and peri-operative complications.

3 patients died in the first 3 months from reasons not related to surgery, with no recorded evidence of fracture healing and were excluded from the study and 1 was too frail to attend follow up. The remaining 16 cases were followed up for a mean of 3 years. The mean time to radiological union was 5 months (range: 2–11) and the mean time to clinical union was 4.9 months (range: 2–17). The mean Modified Harris Hip Score in these patients was 66.5 (range: 35.2–97). One patient had further surgery for a delayed union and there was one failure of fixation. The mean hospital stay was 10.8 days and the mean time to fully weight bear 38.1 days.

This study suggests that there is a valid role for the use of the in-cement revision technique in Vancouver type B periprosthetic femoral fractures in a highly selected group of elderly patients unsuitable for lengthy reconstructive procedure

Introduction: Restoration of an anatomical hip centre frequently requires limb lengthening, which increases the risk of nerve injury in the treatment of Crowe 4 DDH.

Objective: Prospective evaluation of SDTSO with Cemented Exeter Femoral Component.

Material and Methods: 15 female patients (18 hips – 3 bilateral) with a mean age at time of operation of 51 years followed-up for a mean of 77 months (11 to 133). 16 cemented and 2 uncemented acetabular components were implanted. Exeter cemented DDH stems were used in all cases. No patient lost to follow up.

Results: 18 Crowe IV hips. Charnley-D’Aubigne-Postel score for pain, function and range of movement were improved from a mean of 2, 2,3 to 5,4,5 respectively. One osteotomy failed to unite at 14 months and revised successfully. Clinical healing was achieved at a mean of 6 month while radiological at a mean of 9 months. The mean length of the excised segment was 3cm and the mean true limb lengthening was 2cm. 3.5mm DCP plate with unicortical screws was used to reduce the osteotomy, and intramedullary autografting performed in all cases. Mean subsidence was 1mm and no stem was found loose at the latest follow up. No sciatic nerve palsy observed and no dislocation.

Conclusion: Cemented Exeter femoral components perform well in the treatment of Crowe IV DDH with SDTSO. Transverse osteotomy is necessary to achieve derotation and reduction can be maintained with a DCP plate. Intramedulary autografting prevents cement interposition at the osteotomy site.

Purpose: The authors would like to report a technical innovation in cemented hip arthroplasty. The new device, a “rim cutter” (patent pending) was designed in Exeter and aims at improving the surgical technique of insertion of cemented sockets. The principle aim of this innovation is to cut a rim around the periphery of the acetabulum to a set depth so that the flange of the socket seats into this rim and thus by sealing the space underneath the flange, there is a sustained rise in cement injection pressure behind the socket during implantation. This, improves cement macro and micro interlock, creates a congruent cement mantle with no radioluciencies, especially in the highly predictive DeLee-Charnley Zone I.

Materials and methods: A retrospective clinical study was performed in order to assess the radiological result of the use of the rim cutter. Two groups of patients with 30 in each group (consecutive cases) were enrolled in the present study. In group A, the rim cutter device was used while in group B, the acetabulum was prepared without the use of the rim cutter. In all cases an Exeter contemporary cup and stem were used. All cases were evaluated with postoperative radiographs which were analysed to record the anatomic measurements with regard to:

i) centre of rotation of the socket (COR),

These values were compared with the equivalent measurements made for a normal contralateral hip. In addition to these measurements, any radiolucent line in any zone was recorded. The post-operative film was templated using Orthoview (TM, Southampton, Hampshire) software, which is a digital X ray templating system.

Results: The group where the rim cutter was used showed significantly improved radiological parameters. In this group (group A) the socket was placed closer to the normal centre of rotation (COR) compared to the other group (group B) where the rim cutter was not used. This difference was statistically significant (p< 0.0001). Two cases in the non rim cutter group showed radioluciencies in Zone I. Similarly, with regard to the lateralisation of the COR, the implants in the rim cutter group were closer to the COR of the contralateral normal hip The cement mantle was found to be more concentric in the rim cutter group (in group A, more patients had the same width of cement mantle in all Zones) than the non rim cutter group. This difference between the two groups was statistically significant (p< 0.0001).

Conclusions: The introduction of the new “rim cutter” represents a progression in the technique for the preparation of the acetabulum in cemented hip arthroplasty. It indicates a further step, following the introduction of flanged sockets.

Introduction: Recurrent dislocation is a significant problem after total hip replacement. Aetiology is multifactorial and treatment should address the reason for dislocation. The use of a constrained tripolar liner is an option in the surgical treatment of dislocation.

Methods: A retrospective review was carried out of patients who have undergone revision hip surgery and had a constrained liner cemented into the acetabulum. Patients were identified from a computer database. All patients had a constrained liner cemented onto a satisfactory pre-existing cement mantle, cemented into a reconstruction ring, or cemented into a well fixed cementless shell. The Osteonics Tripolar Liner was used in all cases and the outer aspect of the tripolar liner was prepared with a burr to create grooves and thus improve cement interlock. Data collected included demographics, reason for revision, components used, re-revision rate, outcome and survival.

Results: There were 58 cases identified where a cemented constrained liner was inserted at revision hip surgery. Average age at time of surgery was 77years (range 40–94). Reason for use of a constrained liner was recurrent dislocation in over 95% of cases. There were 9 patients who died with less than 2 years follow-up; they were excluded, leaving a study group of 49 cases. Average duration of follow-up was 46months (range 24–76).

There have been 4 infections, one of which required removal of prostheses and 2 stage revision. There was one case of fall post-operatively and fracture of the contra-lateral femoral neck. There have been 3 implant failures requiring re-revision. All failures were due to disarticulation of the liner, 2 of which occurred in the same patient on separate occasions. There have been no revisions for loosening, and there have been no cases of failure at the bone-cement interface or at the cement-cement interface with the cement-in-cement technique. Overall survival of the cemented constrained liner was 91.8% at average 3.8years.

Conclusion: This study demonstrates that a cemented constrained tripolar liner is a viable option in revision hip surgery, particularly in the treatment of recurrent dislocation.

Introduction & methods: The aim of this study was to determine the medium term survivorship and function of the Exeter Universal Hip Replacement when used in younger patients, a group that is deemed to place high demands on their arthroplasties. Since 1988, The Exeter Hip Research Unit has prospectively gathered data on all patients who have had total hip replacements at the Princess Elizabeth Orthopaedic Hospital. There were 130 Exeter Universal total hip replacements (THR) in 107 patients who were 50 years or younger at the time of surgery and whose surgery was performed at least 10 years before. Mean age at surgery was 42y (range 17y to 50y.) Six patients who had 7 THRs had died leaving 123 THRs for review. Patients were reviewed at an average of 12.5 years (range 10 – 17 years). No patient was lost to follow up. Results: At review, 12 hips had been revised. Of these, 9 were for aseptic loosening of the acetabular component and one cup was revised for focal lysis and pain. One hip was revised for recurrent dislocation. One femoral component required revision in 1 case of infection. Radiographs showed that a further 11(10%) of the remaining acetabular prostheses were loose but that no femoral components were loose. Survivorship of stem and cup from all causes was 92.7%, at an average of 12.5 years. Survivorship of stem only from all causes was 99% and from aseptic loosening was 100%.

Conclusion: The Exeter Universal Stem is shown to perform extremely well in the younger patient. No femoral component became loose and only 9 acetabular components were revised for aseptic loosening

Introduction: Removal of all foreign material is the normal practice at the time of revision arthroplasty for sepsis. However, removal of well fixed bone cement is time consuming, can result in significant bone stock loss and increases the risk of femoral shaft perforation or fracture. We report our results of 2 stage revision hip arthroplasty with retention of a well fixed femoral cement mantle.

Methods: If the femoral cement mantle demonstrated good osseo-integration at first stage it was left in-situ. Following Girdlestone excision arthroplasty (GEA), patients received local and systemic antibiotics and underwent reconstruction at a second stage. At the second stage the femoral component was cemented into the old mantle.

Results: 16 patients (M:F 5:11) had at least 3 years follow up (mean 80 months, range 43 to 91). 1 patient died of an unrelated cause at 53 months. Recurrence of infection was not suspected in this case. The mean time to first stage revision was 57 months (3 to 155). The mean time between first and second stages was 9 months (1 to 35). Organisms were identified in 14 (87.5%) cases (5 Staphylococcus Aureus, 4 Group-B Streptococcus, 2 Coagulase negative Staphylococcus, 2 Enterococcus Faecalis, 1 Escheria Coli). At second stage 5 (31.2%) acetabula were uncemented and 11 (68.8%) were cemented. There were 2 complications, 1 patient dislocated 41 days post-operatively and a second patient required an acetabular revision at 44 days for sudden loss of fixation. No evidence of infection was found at re-revision. Currently no patients are suspected of having a recurrence of infection.

Discussion: In-cement revision of the femoral component following GEA for sepsis is not associated with a higher rate of recurrence of infection. Advantages include a shorter operating time, reduced loss of bone stock, improved component fixation and a technically easier second stage procedure.