Revision total hip arthroplasty. Current role of polymethylmethacrylate

In 29 consecutive failed total hip arthroplasties revised during a 15-month period, cement fixation was used in 14 and cementless fixation in 11. A combination of the two techniques was used in four patients. Analysis of the indications for one or the other fixation type showed that the quality of bone stock and the location of bone deficiency were the most important criteria. The use of a fixation technique that suited the method of bone repair, i.e., autografts, allografts, or a combination of the two, was all-important. Cement technique alone was generally used when bone stock was intact and healthy. Cement was also used in combination with protrusio screens and allografts for gross acetabular deficiencies. Cementless, porous ingrowth technique, together with autografts, was preferred for femoral deficiencies or minor acetabular deficiencies. Bipolar prostheses with compressed, fragmented allografts were used as salvage procedures in gross acetabular deficiencies in older patients, especially when the femoral component did not need to be exchanged.