Perspective from Timothy S. Brown, MD
Source:

Haddad FS. Paper 65. Presented at: Current Concepts in Joint Replacement Spring Meeting; May 18-20, 2020 (virtual meeting).

Disclosures: Haddad reports he is a consultant for and receives royalties and research support from Corin, MatOrtho Limited, Smith & Nephew Inc. and Stryker.
May 27, 2020
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Cemented THA may play a role in revision surgery

Perspective from Timothy S. Brown, MD
Source:

Haddad FS. Paper 65. Presented at: Current Concepts in Joint Replacement Spring Meeting; May 18-20, 2020 (virtual meeting).

Disclosures: Haddad reports he is a consultant for and receives royalties and research support from Corin, MatOrtho Limited, Smith & Nephew Inc. and Stryker.
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Despite surgeons going a cementless route with revision total hip arthroplasty, a presenter at the Current Concepts in Joint Replacement Spring Meeting noted, although rare, there is a role for cemented revision in THA.

“[Cemented revision] is going to be guided by your preference, but it is particularly indicated in the elderly, those [who are] low demand, those who are osteopenic – if the bone is poor – and, bear in mind, you need some cancellous bone,” Fares S. Haddad, MD, FRCS, said in his presentation. “If there is no cancellous bone proximally, you have to go a little bit longer; but sometimes, you can make it look like a primary.”

One technique for cemented revision is impaction grafting, which is ideal for younger patients with type 2 and 3A bone, according to Haddad. Although a difficult procedure, he noted impaction grafting can successfully restore bone and provide a durable reconstruction. However, Haddad said this technique has its problems and should be performed by surgeons who do a high volume of cemented revision THAs.

Fares S. Haddad
Fares S. Haddad

“There is a risk of fracture if you impact hard. it is tough to get a good cement mantle unless you are used to doing it. It takes much longer than doing a cementless taper,” Haddad said.

He added cement in cement revision is another technique that has become useful in cemented revision THA. As long as the patient has an intact cement mantle and a polished tapered stem, Haddad noted it is possible to “cement into old cement.”

“One caveat I have is the existing cement must be solidly fixed for you to use this technique, but it is a great get out of jail card when you have cement in situ,” Haddad said. “You just get it out and you can re-cement within it. Sometimes some fairly tricky cases can be made simple using this technique.”