Cement Beads at First Stage Improve Femoral Endosteal Recovery: A Comparative Study of Revision and Primary Taper Slip Femoral Components

Abstract

AbstractDebate continues about the merits of nonarticulating cement beads versus articulating cement spacers. This unit believes beads promote femoral endosteal bone regeneration producing an environment conducive to cementing at second stage. This article assesses the femoral cement mantle of matched primary and revision cemented taper slip stems (CTSSs). We performed a retrospective cohort study of all second stage CTSSs then selected a randomized group from primary joints from the arthroplasty database. The two revision hip fellows assessed the initial postop radiograph for femoral cement quality using the Barrack grading system. Results were analyzed using SPSS for interobserver reliability and quality of cementing. A total of 105 patients were identified as having received a CTSS at second stage and 105 primaries randomly selected. The average age was 81 years in the revision group and 79 years in the primary group. The revision group contained 54% female patients and the primary group contained 56%. In the primary group 73% on anteroposterior (AP) were grade A and 65% on lateral. In the revision group 77% on AP were grade A and 76% on the lateral. The interclass correlation coefficient showed good correlation between assessors. Only the lateral cementing demonstrated a significant difference between groups in favor of the revision group. This article suggests that the use of beads at first stage followed by a cemented femoral prosthesis at second stage will have equal to, or slightly better cementing than those receiving a primary hip replacement. We believe that cement can have additional benefits in second stage revisions such as further delivery of antibiotics into the effective joint space. As revision surgeons we aim to foster as many options as possible for the subsequent reconstruction. The major limitation of this study is the low number of articulating spacers used in this institution.