Survivorship of the C-Stem in cement-in-cement revision hip arthroplasty

Published Date: 19th July 2026

Publication Authors: As-Sultany. M

Introduction
Cement-in-cement (CiC) is a well-established technique in revision hip arthroplasty. It involves cementing a new femoral stem into an existing intact cement mantle. It is less invasive than the conventional technique of removing well-fixed cement. This study evaluates the clinical and radiological outcomes of the C-Stem in CiC revision hip arthroplasty at the design centre.

Methods
A retrospective analysis was conducted using a prospectively maintained database of CiC revision hip arthroplasties performed between July 2015 and 2023. Inclusion criteria included patients undergoing CiC femoral revision with a C-Stem and have a minimum of 1 year follow-up. Patients with a disrupted cement mantle, infection at index surgery, or less than 1 year of follow-up were excluded. Data on indications, complications, radiographs and survivorship were analysed. Kaplan–Meier survival analysis was performed with revision for any cause as the endpoint.

Results
There were 102 cases, of which 78 had at least 1 year of clinical and radiological follow-up. The average patient age was 71 years (47–90). The mean follow-up was 41 (25–72) months. The 3 most common reasons for revision surgery were cup loosening (60%), dislocation (16%) and stem loosening (11%). Following revision arthroplasty using the CiC technique, there were a total of 11.8% stem revisions. Kaplan-Meier survival analysis was 86% (95% confidence interval 76–96) at 8 years for all-cause stem revisions. There were no re-revisions of the femoral stem for aseptic loosening. The majority of cases (93%) maintained their preoperative Barrack grading.

Conclusions
This largest single study demonstrates favourable medium-term implant survival with the C-Stem in CiC revision hip arthroplasty. This technique remains viable in carefully selected revision cases since it is associated with a much lower complication and risk profile. Further studies with longer follow-up and functional outcome scores are warranted.

Yadav, AK; As-Sultany, M et al. (2026). Survivorship of the C-Stem in cement-in-cement revision hip arthroplasty. HIP International. Pub online 19 Jul. [Online]. Available at: https://doi.org/10.1177/11207000261453803 [Accessed 23 July 2026]