Cement-in-cement revision with the Exeter Short Revision Stem: A review of 50 consecutive hips

Abstract

Revision of a well-fixed cemented femoral stem is technically challenging. The Exeter Short Revision Stem (SRS) was developed to facilitate cement-in-cement revision mitigating some of these challenges. We present the short to mid-term results of 50 cement-in-cement revisions performed with this implant.A retrospective review of all cement-in-cement revision with the Exeter SRS, at our institution, over a seven-year period between 2007 and 2014 was conducted. Records were assessed for radiological and clinical component loosening at greater than 12 months follow-up and for revision and complications at all time points. An Oxford Hip Score (OHS) and Numeric Rating Scale (NRS) for groin and thigh pain at rest and initial mobilisation were obtained. 50 implants in 46 patients were identified. Radiographic and clinical follow-up was available for 42 and 38 implants respectively at greater than 12 months. Mean radiographic follow-up was 5.1 years and clinical 4.9 years. There was no radiographic or clinical evidence of loosening. 3 revisions were performed, one for each of recurrent dislocation, infection and stem breakage. Median OHS was 39 (IQR 12) and mean NRS for groin pain at rest and initial mobilisation was 1.7 and 1.7 respectively and NRS for thigh pain at rest and initial mobilisation was 1.3 and 1.6 respectively with mean follow-up of 6.9 years.The Exeter SRS provides a viable option for cement-in-cement stem revision, with low revision, complication and loosening rates and good patient reported outcomes at short to mid-term follow up.

Analysis of the Exeter V40 femoral stem prosthesis fracture

“… 2 , 8 , 17 Within the V40 range, multiple predisposing factors have been proposed, associated with both surgical factors (notch sensitivity, increased offset and femoral head size, propagation from the insertion hole, 2 , 5 , 13 , 18 , 19 ) and patient factors (higher activity level and raised BMI). 15 , 19 , 24 In our study, neck fractures were associated with standard-length stems (83%) and raised BMI (83%). Previous metallurgical studies of Exeter stem neck fractures demonstrate ductile deformation highly indicative of a high-cycle low-stress fatigue failure.…”

“… 27 , 28 More recently, multiple studies in Asia and the UK demonstrated survival rates of 100% for aseptic loosening for the Exeter Universal 35.5 mm shorter stems at ten and eight years, respectively. 27 , 29 The success of the V40 Exeter short revision stem (44/00/125) introduced in 2005 is well published in providing an implant which facilitates restoration of leg length, offset and stability, while limiting bone loss secondary to excess reaming in revision 22 , 24 , 30 and recently primary THA. 30 …”

Open Reduction and Internal Fixation and Cement-In-Cement Revision for Selected Vancouver B Proximal Femur Periprosthetic Fractures

“…Berg et al. [ 8 ] presented a case series of 50 short Exeter stems (44/00/125) used in c-in-c revisions, none of which were performed for periprosthetic fracture, and had 1 stem fracture (2%) in their cohort. Woodbridge et al.…”

“…The c-in-c technique has been well described for its use in revision arthroplasty in other settings [ [8] , [9] , [10] , [11] , [12] ], but little has been described regarding its use in periprosthetic fractures. Woodbridge et al.…”

The Effect of Cement Aging on the Stability of a Cement-in-Cement Revision Construct

“…Quinlan et al had an excellent outcome using the cement-in-cement technique [22]. Other studies also showed results with the new technique and a decrease in complications due to the revision [5,13,23,24]. Sandiford et al also investigated the cement-in-cement technique in multiple revised total hip replacements.…”