Cement mantle retention: filling the hole.

Revision total hip surgery requires a number of techniques that optimizes outcomes while minimizing bone loss. One such technique that has proven useful in revision of the femoral components in revision total hip surgery is leaving an intact cement mantle in place and cementing a new prosthesis within the intact cement mantle. Careful patient selection and preoperative planning are essential for the successful implementation of this technique. The appropriate indications are: (1) if the original stem is broken, but the cement mantle is intact, (2) when removing a well-fixed, cemented stem to improve exposure for an acetabular revision, increase femoral offset, or femoral head diameter, and (3) when removing a debonded femoral component. Although the cement-within-cement revision technique is rarely used, it is an important technique to have in your portfolio. However, it is also important to keep in mind some of the drawbacks of cement-within-revisions and to consider these factors when deciding whether this technique is appropriate for a specific patient.