Cement-in-cement revision for Vancouver B2 periprosthetic femoral fractures: indications, surgical principles, and clinical outcomes - a narrative review.

Vancouver B2 periprosthetic femoral fractures represent a major surgical challenge, particularly in elderly and frail patients. Revision with long uncemented stems remains the standard treatment, but it is technically demanding and associated with substantial surgical morbidity. The cement-in-cement technique has emerged as a less invasive alternative that may reduce operative burden in carefully selected cases. The aim of this narrative review was to critically evaluate the current evidence regarding the use of the cement-in-cement technique for the management of Vancouver B2 periprosthetic femoral fractures. A literature search was conducted using PubMed and Scopus to identify studies reporting indications, surgical principles, and clinical outcomes of this technique. Available evidence suggests that cement-in-cement revision is associated with complication and re-revision rates comparable to those of uncemented long-stem revision, while offering shorter operative times and similar implant survivorship. The cement-in-cement technique may be a viable option for selected patients undergoing revision hip arthroplasty, particularly when the distal cement mantle is well-fixed. However, current evidence remains limited, and further studies with larger cohorts and longer follow-up are required to better define indications and long-term outcomes. Level of evidence: Level IV.