Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.