{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T18:06:10Z","timestamp":1784657170735,"version":"3.55.0"},"reference-count":21,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,19]],"date-time":"2026-07-19T00:00:00Z","timestamp":1784419200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["HIP International"],"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>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\u2009year follow-up. Patients with a disrupted cement mantle, infection at index surgery, or less than 1\u2009year of follow-up were excluded. Data on indications, complications, radiographs and survivorship were analysed. Kaplan\u2013Meier survival analysis was performed with revision for any cause as the endpoint.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>There were 102 cases, of which 78 had at least 1\u2009year of clinical and radiological follow-up. The average patient age was 71 years (47\u201390). The mean follow-up was 41 (25\u201372) 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\u201396) at 8\u2009years 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/11207000261453803","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T06:12:06Z","timestamp":1784527926000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Survivorship of the C-Stem in cement-in-cement revision hip arthroplasty"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8594-397X","authenticated-orcid":false,"given":"Amit Kumar","family":"Yadav","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, Ulster Hospital, Belfast, Northern Ireland, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"As-Sultany","sequence":"additional","affiliation":[{"name":"Mersey and West Lancashire Teaching Hospitals NHS Trust, Prescot, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Siney","sequence":"additional","affiliation":[{"name":"John Charnley Research Institute, Wrightington Hospital, Wigan, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ishmita","family":"Paul","sequence":"additional","affiliation":[{"name":"Hillingdon Hospital NHS Foundation Trust, Uxbridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asim","family":"Rajpura","sequence":"additional","affiliation":[{"name":"Wrightington Hospital, Wigan, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Kay","sequence":"additional","affiliation":[{"name":"Wrightington Hospital, Wigan, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,19]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31777-X"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200704000-00012"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.88B6.17037"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/112070000801800402"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.75B6.8245073"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.91B5.21621"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-010-1167-5"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.99B2.BJJ-2016-0076.R1"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.99B4.BJJ-2016-1222.R1"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jos.2016.03.013"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.3928\/0147-7447-20050802-04"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1054\/arth.2001.28374"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-197906000-00002"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.74B3.1587883"},{"key":"e_1_3_2_16_2","first-page":"477","article-title":"Experience with the Exeter total hip replacement since 1970","volume":"19","author":"Fowler JL","year":"1988","unstructured":"Fowler JL, Gie GA, Lee AJ, et al. 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Orthop Clin North Am 1988; 19: 477\u2013489.","journal-title":"Orthop Clin North Am"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-007-0470-0"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2014.05.002"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.103B7.BJJ-2020-1953.R2"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.3889\/oamjms.2019.710"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-010-1251-6"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.14311\/CTJ.2026.56.01"}],"container-title":["HIP International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/11207000261453803","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/11207000261453803","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/11207000261453803","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T17:47:18Z","timestamp":1784656038000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/11207000261453803"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,19]]},"references-count":21,"alternative-id":["10.1177\/11207000261453803"],"URL":"https:\/\/doi.org\/10.1177\/11207000261453803","relation":{},"ISSN":["1120-7000","1724-6067"],"issn-type":[{"value":"1120-7000","type":"print"},{"value":"1724-6067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,19]]},"article-number":"11207000261453803"}}