Mix and match strategies in revision total hip arthroplasty: a review of techniques and outcomes

Abstract

This review evaluates the clinical indications, surgical rationale, and outcomes of six targeted component-retention strategies in revision total hip arthroplasty (THA) designed to reduce operative morbidity and preserve host bone stock. This is a narrative review. A structured but non-systematic search of PubMed/MEDLINE and Scopus was used to identify contemporary clinical cohorts, joint registry data, and biomechanical analyses, with the evidence organised sequentially across acetabular and femoral subsites. Acetabular retention of stable metal-on-metal shells with dual-mobility bearings minimizes surgical trauma and yields exceptionally low dislocation rates (0% to 4%). Cementing highly cross-linked polyethylene (XLPE) or dual-mobility liners into secure or revision cups successfully decouples biological fixation from alignment, ensuring high mid-term survivorship. On the femoral side, trunnion adapter sleeves protect the head-neck junction during isolated bearing exchanges, demonstrating reliable 10-year survivorship (85%). For unavoidable stem extractions with sound cement mantles, cement-in-cement revision offers a rapid pathway; utilizing high-fatigue-resistant cobalt-chromium alloys instead of stainless steel structurally mitigates the rare risk of cantilever stem fracture. Lastly, for uncontained bone loss or profound osteopenia, extended long cemented stems and allograft-stem composites bypass major defects to provide immediate biological and mechanical rigidity. In appropriately selected patients, targeted component retention appears to offer a bone-preserving alternative to wholesale hardware explantation, although the supporting evidence is predominantly observational.