Cement Fixation Research Articles

(vii) Fixation in femoral revision: the role of cement

Abstract Evidence drawn from national joint registries and research from multiple centres affirm that highly successful long-term results can be achieved after primary hip replacement using polymethylmethacrylate (PMMA) cement fixation. Revision surgery provides a more diverse spectrum of surgical challenges, for which a number of different surgical techniques may be required. This paper reviews the femoral revision techniques that may be employed using PMMA fixation. It discusses the indications for and strengths of these techniques, as well as their limitations. It presents the results of the different techniques in standard situations as well as those for more demanding scenarios such as infection or femoral fracture. These results show that PMMA fixation of the femoral component at revision surgery is versatile and effective and brings with it several unique advantages over other methods of femoral revision.

Quality of life in patients after total cement or cementless hip arthroplasty

In this article, the authors compared the quality of life of patients after total hip arthroplasty with cementless (group 1) and cement (group 2) fixation of prosthetic components. Obtained similar data in both groups. The authors recommend cementless total hip arthroplasty for fractures of the femoral neck as an alternative to cement fixation method in terms of osteoporosis.

Return to theatre for elective hip and knee replacements: what is the relative importance of patient factors, surgeon and hospital?

The aim of this study was to define return to theatre (RTT) rates for elective hip and knee replacement (HR and KR), to describe the predictors and to show the variations in risk-adjusted rates by surgical team and hospital using national English hospital administrative data. We examined information on 260 206 HRs and 315 249 KRs undertaken between April 2007 and March 2012. The 90-day RTT rates were 2.1% for HR and 1.8% for KR. Male gender, obesity, diabetes and several other comorbidities were associated with higher odds for both index procedures. For HR, hip resurfacing had half the odds of cement fixation (OR = 0.58, 95% confidence intervals (CI) 0.47 to 0.71). For KR, unicondylar KR had half the odds of total replacement (OR = 0.49, 95% CI 0.42 to 0.56), and younger ages had higher odds (OR = 2.23, 95% CI 1.65 to 3.01) for ages < 40 years compared with ages 60 to 69 years). There were more funnel plot outliers at three standard deviations than would be expected if variation occurred on a random basis. Hierarchical modelling showed that three-quarters of the variation between surgeons for HR and over half the variation between surgeons for KR are not explained by the hospital they operated at or by available patient factors. We conclude that 90-day RTT rate may be a useful quality indicator for orthopaedics.

Successful Limb Salvage of a "Too-Short Segment" of the Proximal Part of the Femur with Use of a Compression Osseointegration Implant: A Case Report.

After resection of a bone tumor, reconstruction can be performed with use of a variety of techniques, including large-segment allografts, allograft-prosthetic composites, endoprostheses, and other types of tissue-transfer procedures1-5. All of these options rely on healthy native bone and soft tissues. The difficulty of achieving a successful outcome increases as the segment of remaining normal bone decreases6,7. For example, endoprosthetic implants with stems require a sufficient length of bone to achieve either press-fit or cemented fixation. Similarly, allografts and vascularized bone transfers require healthy bone to achieve adequate fixation8. When short segments of bone remain after tumor resection, traditional implants will not fit, and the surgeon has to rely on alternatives such as allograft-prosthetic composites, custom implants, or replacement of the entire bone (as with total replacement of the femur). Determining what constitutes sufficient bone to perform a reconstruction is not known and depends on the surgeon’s experience, the implants that are available, the patient’s acceptance of surgical risks, and the resources available for postoperative rehabilitation. To the best of our knowledge, there are no studies in the literature that specifically provide information or guidance on how to perform an endoprosthetic reconstruction of the femur when only the proximal metaphysis is intact. We present a case of a seventy-five-year-old man who underwent successful endoprosthetic replacement of the entire femur, distal to the lesser trochanter and including the knee joint, after complications associated with a chondrosarcoma resection. This case demonstrates a novel technique with use of a compression osseointegration implant for preservation of the native hip joint while replacing almost the entire femur. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A seventy-five-year-old man presented with a four-to-six-month history of pain …

The Proportion of Perioperative Mortalites Attributed to Cemented Implantation in Hip Fracture Patients Treated by Hemiarthroplasty

IntroductionBone cement for fixation of prostheses, comorbidity and age have been previously shown to be associated with increased relative risk of mortality within the first day of surgery. However, the proportion of mortalities associated to each of these exposures is not adequately expressed by relative risk estimates.Materials and methodsThe attributable fraction (AF), i.e. the fraction of diseased individuals attributed to a given risk factor, was estimated for cemented fixation of hip prostheses in the elderly (>65 years) with a hip fracture. Dementia, symptomatic comorbidity (American Society of Anesthesiologists (ASA)≥ 3), old age (≥85 years), male gender, and a delay of 24 hours or more from fracture to operation were considered as additional risk factors for a fatal outcome in close proximity to surgery.ResultsIn the entire study population (n = 11210), the unadjusted and adjusted population AFs of cemented fixation on mortalities within the first day after surgery were 0.58 (95% CI 0.28-0.76) and 0.59 (95% CI 0.29-0.76), respectively. Symptomatic comorbidity and old age as risk factors had population AFs of 0.71 (95% CI 0.51-0.83) and 0.55 (95% CI 0.39-0.67), respectively. Male gender, dementia and time from fracture to operation all had considerably lower population AFs.ConclusionsThe estimated AFs on perioperative mortality in hip fracture patients treated by hemiarthroplasty showed that about half of the mortalities within the first day of surgery could be associated with the use of bone cement.

Tibial Rotational Alignment Was Significantly Improved by Use of a CT-Navigated Control Device in Total Knee Arthroplasty

This study compared the accuracy of three methods to set tibial component rotational alignment: (1) conventional method, the anteroposterior (AP) axis was determined by the surgeon using anatomical landmarks; (2) partial-navigation method, the tibia was prepared according to the AP axis using a CT-based navigation system and the component was manually positioned; (3) full-navigation method, the tibial component was positioned and fixed with cement under the control of navigation using a newly developed instrument. The conventional method showed considerable deviation (range, −18.6° to 14.7°), and the partial-navigation method also showed considerable deviation (−11.3° to 8.1°). In contrast, the full-navigation method significantly improved the accuracy of alignment (−2.9° to 2.1°). The tibial component can become malaligned during cement fixation, even after proper bone preparation.

Femoral revision with impaction bone grafting and a cemented polished tapered stem

Biological repair of femoral bone loss using bone impaction grafting. Reconstruction of the centre of rotation of the hip using a cemented stem, the size and offset of which are at the discretion of the surgeon. Femoral implant loosening with bone loss. Infection, neurological disorders, noncompliant patient. Extraction of the loose femoral implant, cortical reconstruction using meshes if required, impaction bone grafting with special instruments, cement fixation of a polished tapered stem. Individualized period of bed rest and limited weight bearing. Impaction bone grafting and a cemented polished stem were used to perform 33femoral reconstructions. After a mean follow-up of 15years, no femoral reconstruction had to be revised. One unrecognized intraoperative fracture healed after nonsurgical treatment, three postoperative femoral fractures healed after plate fixation with the stem left in situ. The average Harris Hip Score improved from 49prior to surgery to 85points thereafter. Kaplan-Meier analysis with femoral revision for any reason as the end point showed a survival rate of 100 %.

Short-term results of the PROSNAP linked elbow prosthesis with a snap-in structure and modular flange for the reconstruction of severely damaged rheumatoid elbows

We aimed to evaluate the early clinical results of the reconstruction of problematic elbow joints due to rheumatoid arthritis (RA) using a PROSNAP linked elbow prosthesis (Kyocera Medical, Osaka, Japan) for total elbow arthroplasty. Seventeen elbows in 14 RA patients were replaced with a PROSNAP elbow with cement fixation. The patients comprised 1 man and 13 women, with a mean age of 63.9 years (range, 52-83 years) at the time of surgery. The preoperative conditions of the elbows were arthritis mutilans (n = 10), an ankylosed or stiff elbow with a preoperative range of motion of 45° or less (n = 4), and loosening of a primary total elbow arthroplasty (n = 3). The mean follow-up period was 47.7 months (range, 32-69 months), with a 100% follow-up rate. The clinical outcome of the elbows was evaluated by the Mayo Elbow Performance Index (maximum, 100 points). The mean postoperative Mayo Elbow Performance Index score improved from 57.6 points to 97.1 points. Preoperatively, 3 of the 17 elbows were judged as good, 7 as fair, and 7 as poor; at final follow-up, 16 elbows were judged as excellent and 1 as good. Complications were noted in 1 elbow (6%), which had undergone a postoperative fracture. The PROSNAP elbow prosthesis can be safely implanted through a relatively easy procedure and provides satisfactory short-term clinical outcomes for the reconstruction of severely damaged RA elbows. Level IV, case series, treatment study.

Cemented Versus Cementless Fixation of a Tibial Component in LCS Mobile-Bearing Total Knee Arthroplasty Performed by a Single Surgeon

Although cemented tibial fixation of total knee arthroplasty accepted as the gold standard, cementless fixation as a means to supplement disadvantages of cemented fixation continues to be of interest to clinicians. One hundred sixty-eight consecutive knees undergoing primary knee arthroplasty for osteoarthritis were randomly assigned to receive either a cemented (86 knees) or cementless (82 knees) fixation of tibial component. We report the outcomes at 8 to 11years (mean, 9.5). The mean KSS, the HSS score, the mean WOMAC, the mean ranges of knee movement and radiological results were similar in both groups. No osteolysis was identified in either group. The rate of survival of the femoral and tibial components was 100% in both groups at final follow-up.

Clinical and radiographic results of cementless reverse total shoulder arthroplasty: a comparative study with 2 to 5 years of follow-up

Most studies of reverse total shoulder arthroplasty (RTSA) involve cemented humeral stems. To our knowledge, this is the first study to compare the results of cementless RTSA, using a porous-coated stem designed for uncemented fixation, with cemented RTSA. A prospective database of patients undergoing RTSA was retrospectively reviewed for patients with a diagnosis of cuff tear arthropathy or severe rotator cuff deficiency with minimum 2-year follow-up. Of these, 37 patients had cemented RTSA and 64 patients had cementless RTSA. Outcome measures included Constant-Murley scores, American Shoulder and Elbow Surgeons scores, visual analog pain scale scores, range of motion, patient satisfaction, and radiographic evidence of complication. Compared with preoperative values, both cohorts demonstrated significant improvements (P<.01) in all functional scores, active forward elevation, and active internal rotation. There was no significant difference (P>.05) in comparing the changes in these values after surgery between the cemented and cementless cohorts. On radiographic evaluation, there was no evidence of loosening or humeral components "at risk" of loosening in either group. There was no significant difference (P=1.0) in the incidence of humeral component radiolucent lines between the cemented and uncemented cohorts. There was no significant difference (P=.30) in the incidence of scapular notching between the cemented (n=8) and uncemented (n=10) cohorts. Cementless fixation of a porous-coated RTSA humeral stem provides clinical and radiographic outcomes equivalent to those of cemented stems at minimum 2-year follow-up. With advantages such as simplified operative technique, no cement-related complications, greater ease of revision, and long-lasting biologic fixation, uncemented fixation may provide several benefits over cemented fixation.

Tumor Endoprosthesis Revision Rates Increase With Peri-Operative Chemotherapy But Are Reduced With the Use of Cemented Implant Fixation

Chemotherapy may reduce osseointegration of tumor endoprosthesis, while delaying chemotherapy may reduce survival. We studied the effects of chemotherapy and cemented fixation on tumor endoprosthesis survivorship with a retrospective analysis of 50 consecutive patients receiving lower limb salvage surgery. We compared rates of radiographic loosening/revision and effect of cement fixation between chemotherapy/no chemotherapy cohorts. Chemotherapy increased the total revision rate (HR=3.8 [1–14], P=0.033), but did not affect aseptic loosening. Cement fixation reduced revision for loosening (HR=0.09 (0.008–0.98),P=0.012) and showed less radiographic loosening (HR=0.09 (0.02–0.51),P=0.00066). Cement fixation had lower rates of revision for loosening and radiographic loosening regardless of whether chemotherapy was given. We conclude that for these implants, cement fixation provides superior results to uncemented fixation.

Grammont reversed prosthesis for acute complex fracture of the proximal humerus in an elderly population with 5 to 12 years follow-up

Purpose of the studyThe aim of this retrospective study was to analyze outcome in 23 cases of Delta III reverse ball-and-socket total shoulder prosthesis implantation for acute complex fractures of the proximal humerus in an elderly population with poor bone quality. In this type of population, this procedure could respond to the difficulties of a reliable and efficient re-fixation of the tubercles. Material and methodsFrom 1993 to 2000, 23 Delta III prostheses were implanted by a single operator for acute injury: 18 three-part and four-part fractures and five fracture-dislocations. The study population included two men and 21 women, mean age 75years, ten on the dominant side. Surgery was performed under general anesthesia in the semi-sitting position via the anterolateral approach without osteotomy of the acromion, with 10–20° retroversion of the humeral stem (except in one shoulder) and cement fixation in two. For five shoulders, the tubercles were re-fixed. Postoperative physiotherapy was not possible in all patients. Outcome was assessed with the Constant score and with AP and lateral Lamy radiographs. ResultsSeven patients died so the series included 16 cases for analysis. Complications were: reflex sympathetic dystrophy (n=2), postoperative Acinetobacter infection (n=1) requiring revision to clean and drain allowing preservation of the prosthesis, and early postoperative anterior dislocation (n=1) (10° stem anteversion) with surgical revision to re-orient the stem. At a mean follow-up of 86 months, the Constant score was 60 points (contralateral shoulder, 83 points). Outcome, influenced in cases of re-fixation of the tubercles, was good for pain (14.1), activity (13.3), strength (16.1), anterior elevation (6.5), and abduction (6.5), but very poor for external (1.1) and internal (2.4) rotation. The radiographs showed aseptic glenoid loosening (n=1) at 12 years with surgical revision in 2005; the Constant score at 6 months follow-up was 48 points, inferior scapular notching (n=11) according the Nerot classification (six stage 1, four stage 2, one stage 3, at 2, 4.3, and 5 years follow-up), inferior spurs (n=9) appearing at a mean 2.5 years follow-up (stable after emergence without clinical impact), proximal humeral resorption (n=4) (medially for three at a mean 8 years follow-up and one laterally at 10 years), and a humeral radiolucent line (n=1) at 5 years follow-up. DiscussionFor acute complex fractures of the proximal humerus in elderly subjects with poor bone quality, when effective and reliable re-fixation of the tubercles is difficult or impossible, the reverse ball-and-socket shoulder prosthesis is a possible alternative providing good functional outcome except for rotations, but with the risk of inferior scapular notching. Although not problematic in the medium term, these notches may contribute to glenoid loosening with bone loss in the long term. Nevertheless, this procedure seems to improve the status of patients with such fractures.

Screw and cement augmentation of patella defects in knee arthroplasty

BACKGROUND At primary and revision knee arthroplasty, a defi cient patella with a contained or uncontained defect is often encountered,1,2 especially in the presence of longstanding maltracking. In these cases, reconstruction is diffi cult, leaving an unsupported implant. Following the good outcomes achieved using cement fi xation of large defects of the tibial plateau augmented with screws,3 we describe a technique to address patella defects in cases where patella tracking is a problem and would compromise the fi nal result.

A 5-22-year follow-up study of stemmed alumina ceramic total elbow arthroplasties with cement fixation for patients with rheumatoid arthritis

BackgroundWe determined mid to long-term results of total elbow arthroplasty (TEA) by use of unlinked elbow prostheses with solid alumina ceramic trochleae, and ceramic ulnar stems (stemmed Kyocera type I; SKC-I) for patients with rheumatoid arthritis. Patients and methodsFifty-four elbows of 39 patients were available for detailed clinical and radiographic review after a follow-up period of at least 5 years. The mean follow-up period was 12.6 years (range 5-22 years). Clinical condition before and after surgery was assessed by use of a modified version of the Mayo Elbow Performance Score (MEPS; 0-100 points) and a Japan Orthopaedic Association Elbow score (JOA score; 0-100 points). The radiographs were reviewed and loosening was defined as a progressive radiolucent line >1 mm wide that was completely circumferential around the prosthesis. Clinical records of post-operative events affecting the elbows were used for survival analysis of the prostheses using the Kaplan-Meier method. ResultsThe average modified MEPS and JOA scores improved significantly from 39.7 ± 14.3 to 44.7 ± 9.4, respectively, pre-operatively, to 89.7 ± 15.4 and 83.1 ± 12.8, respectively, post-operatively (P< 0.0001). The functional assessment score also improved from 4.9 ± 2.8 to 8.5 ± 3.3 points (P < 0.0001). With loosening or implant revision defined as end points, the likelihood of survival of the prosthesis for up to 20 years was 92.6 % (95 % confidence interval (CI), 85.6-100.0) or 86.3 % (95 % CI 75.0-97.6), respectively. ConclusionSatisfactory clinical results were obtained after TEA using SKC-I prostheses, which provided excellent pain relief and functional range of motion. The results of our study reveal the high reliability over a long period of the cemented SKC-I prosthesis with an alumina ceramic component.

Corrigendum: Ankle Salvage Procedure without Internal Fixation for Large Bone Defect after Failed Total Ankle Arthroplasty: A Case Report

In treatment of failure in ankle joint replacement therapy, talar avascular necrosis with massive bone defect, talus fracture with severe comminution and bone defect and ankle dislocation, treatment of large bone defects is considerably important for ankle joint stability and union, therefore, the choice of treatment for large bone defects is use of femoral head or iliac crest bone graft and rigid internal fixation. Because first generation total ankle arthroplasty performed for the first time using a cemented fixation technique requires a large amount of bone resection during re-surgery and there is some possibility of a larger bone defect after removal of implants, in cases where prosthesis for the defect is needed, performance of palliative femoral head or iliac crest bone graft and rigid internal fixation can be difficult. We report on a case of a 48-year-old woman who had experienced ankle pain for 25 years since undergoing total ankle arthroplasty. Because the patient had little ankle motion and rigid soft tissue despite a large bone defect caused by aseptic loosening, a good outcome was obtained only for the femoral cancellous bone graft using allo femoral head without internal fixation.

Total knee arthroplasty in patients with dialysis: early complications and mortality.

Total hip arthroplasty (THA) in patients on long-term hemodialysis may result in a high prevalence of complications which related to nature of the disease, and associated cardiovascular conditions. However, the result of total knee artrhopalsty (TKA) in those patients is not clear. The purpose of this study was to retrospectively evaluate the early mortality and complications of TKA performed in patients with dialysis. We retrospectively evaluated 15 dialysis patients (18 knees) who underwent TKA using antibiotic-loaded cement fixation. Fourteen patients had maintained hemodialysis and one patient had continuous ambulatory peritoneal dialysis. The function of the knee was evaluated before operation and postoperatively using Knee Society evaluating system. Postoperative complications and mortality were recorded for all patients. The average follow up period was 25 months (6 to 59 months). There were no mortalities including short-term (≤90 days) or long-term (>90 days) follow up. The mean knee and function scores improved from preoperative 36 points (27~46) and 19.4 points (10~35) to 79 points (68~87) and 81 points (70~95) respectively at the latest follow up. One (6.7%) patient had early postoperative pneumonia (≤90 days). The late (>90 days) complication rate was 20% including 1 sepsis with toe gangrene, 1 recurrent stroke and 1 acute myocardiac infarction. There was no deep prosthetic joint infection or loosening of the components. TKA with antibiotic-loaded cement resulted in a substantial low short-term mortality and deep infections in 15 patients with dialysis. However, a longer term follow up is necessary.

Mechanical characterisation of PMMA/SWNTs bone cement using nanoindenter

The usage of cemented fixation for total hip replacement still exists for older people and patients having voids and irregular femurs. However, the huge difference between the mechanical properties of the cortical bone and bone cement led to inhomogeneous stress transfer in the stem/cement interface. Hence, an attempt was made in this direction to sort out the above mentioned problem by reinforcing the poly(methyl methacrylate) (PMMA) bone cement with single walled nanotubes (SWNTs). The SWNTs were functionalised with alkaline treatment, and the attachment of sodium ethoxide was confirmed by Fourier transform infrared spectroscopy. Later, the polymerisation was done along with the reinforcement of SWNTs, and the mechanical properties were evaluated using the nanoindenter. It is observed that the Young’s modulus and hardness of PMMA were found to be enhanced by 19 and 36% respectively at an optimum concentration of 0·15 wt-% SWNTs. It is concluded that the reinforcement of PMMA by SWNTs significantly increased the mechanical properties, which may be explored for the effective stress transfer in the stem/bone interface.

Causes and countermeasures for contralateral fracture after prosthetic replacement for femoral neck fractures

Objective To investigate causes and treatments for a fracture of the contralateral femoral neck in the elderly with prosthetic replacement for femoral neck fractures.Methods A retrospective analysis was conducted on 85 cases undergone prosthetic replacement for femoral neck fractures between March 2005 and May 2012,including 12 cases in secondary replacement group due to fractures of the contralateral uninjured femoral neck after primary prosthetic replacement and 73 cases in primary replacement group.Variables were compared between the two groups including causes of injury,age,sex,bone density,complications,quality of life,Harris score of the contralateral hip joint,surgical choice.Refracture reasons were evaluated and treatment plans were proposed.Results Immediate cause of injury in all cases was falling.Primary and secondary replacement groups showed mean age of (68.82 ± 5.18) yearsvs (76.83 ± 3.64) years (P＜0.05),male to female ratio of 0.66:1 vs 0.09:1 (P＜0.05),and bone mineral density of (0.507 ± 0.062) g/cm2 vs (0.461 ± 0.095) g/cm2(P ＜0.05).Moreover,cases in the two groups suffered from the associated complications (hypertension,diabetes mellitus,cataract,stroke,rheumatoid arthritis,and Parkinson' s disease).Except for the diabetes mellitus,incidence of the other five basic diseases presented significance differences between the two groups (P ＜ 0.05).Of primary and secondary replacement groups,quality of life was (76.26 ±14.17) points vs (67.86 ± 16.74) points (P ＜ 0.05) ; Harris score of the contralateral hip was (98.66 ±1.39) points vs (90.75 ± 5.39) points (P ＜ O.05).For treatment choice,32 total hip arthroplasty (THA) and 41 femoral head arthroplasty (FHA) with cement fixation in 44 cases and cementless fixation in 29 cases were performed in primary replacement group; two total hip arthroplasty and 10 femoral head arthroplasty with cement fixation in 11 cases and cementless fixation in one were performed in secondary placement group (P ＜ 0.05).Conclusions Fall remains the immediate cause of the contralateral fractures following prosthetic replacement of femoral neck fractures in the elderly.Aging,females,bone density reduction,high-incidence of complications,decreased quality of life,and joint function impairment after the primary prosthetic replacement are unfavorable factors.Prosthetic replacement is still the preferred choice of treatment and surgical procedure is more likely to be the simple cemented FHA. Key words: Femoral neck fracture, aged; Arthroplasty, replacement, hip; Contralateral fractures

Minimally invasive treatment of displaced intra-articular calcaneal fractures using the balloon kyphoplasty technique: Preliminary study

The balloon kyphoplasty approach to the treatment of vertebral fractures can be adapted to achieve the reduction and cement stabilisation of intra-articular compression fractures at other sites, such as the calcaneus. We studied six patients with a median follow-up of 12 months (range, 6-30 months). Fluoroscopy guidance was used to obtain optimal balloon positioning under the joint depression site. Reduction was achieved by expanding the balloon and stabilisation by injecting the cavity with resorbable tricalcium-phosphate cement in the younger patients and polymethyl-metacrylate cement in the two elderly patients with osteoporosis. No internal fixation was used. No intra-operative, postoperative, or delayed complications were recorded. Median hospital stay length was 4.5 days (range, 3-7 days). All the fractures healed within the usual timeframe, without loss of reduction. Median time to full weight-bearing ambulation was 52.5 days (range, 15-75 days). The functional outcomes correlated with the good anatomic results, with a median American Orthopaedic Foot and Ankle Society score of 87.0 (range, 86-97). This preliminary study shows that balloon reduction and cement fixation of intra-articular calcaneal fractures is easy to perform, reproducible, and devoid of specific complications. Good-quality reduction and stabilisation until fracture healing were achieved, and time to recovery of self-sufficiency was short, even in elderly patients with osteoporosis. These results support the use of this minimally invasive technique. Level IV, retrospective study.

Management of Extensive Talar Osteolysis with Agility™ Total Ankle Replacement Systems Using Geometric Metal-reinforced Polymethylmethacrylate Cement Augmentation

The Agility™ Total Ankle Replacement System, almost exclusively without polymethylmethacrylate cement fixation, was the most commonly used implant in the United States from 1998 to 2007. Much attention has been given to the intraoperative complications and incision healing-related problems. However, it is the intermediate- and long-term complications, specifically, aseptic osteolysis, talar component loosening, subsidence, and progressive malalignment, that require careful consideration, because the revision options are limited. We describe a technique for management of extensive talar aseptic osteolysis for revision of Agility™ total ankle replacement systems with use of geometric metal-reinforced polymethylmethacrylate cement augmentation. This technique preserves the subtalar joint, provides immediate component stability and restoration of component alignment and height, and is a cost-effective alternative to other available options and still allows for additional revision should late failure occur.