Clinical evaluation of the cemented Exeter Short 125 mm stem at a minimum of 3 years: A prospective cohort study

Martin, Rebecca; Clark, Natalie; James, J.; Baker, Paul

doi:10.1016/j.jor.2022.02.005

Cited by 5 publications

(3 citation statements)

References 17 publications

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“…A study of these newer short stems did not observe any revisions at three years and also saw the expected improvement in patient-reported outcome measures. 23 There is also a randomized control trial underway that may be of relevance to this research question: the CASINO trial. 24 This trial does not focus on the 44/00/125 as we do, but does investigate the newer 125 mm short stems with more ‘normal’ size and offset geometry.…”

Section: Discussionmentioning

confidence: 99%

Survival of the Exeter V40 short revision (44/00/125) stem when used in primary total hip arthroplasty

et al. 2023

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AimsThe Exeter V40 femoral stem is the most implanted stem in the National Joint Registry (NJR) for primary total hip arthroplasty (THA). In 2004, the 44/00/125 stem was released for use in ‘cement-in-cement’ revision cases. It has, however, been used ‘off-label’ as a primary stem when patient anatomy requires a smaller stem with a 44 mm offset. We aimed to investigate survival of this implant in comparison to others in the range when used in primary THAs recorded in the NJR.MethodsWe analyzed 328,737 primary THAs using the Exeter V40 stem, comprising 34.3% of the 958,869 from the start of the NJR to December 2018. Our exposure was the stem, and the outcome was all-cause construct revision. We stratified analyses into four groups: constructs using the 44/00/125 stem, those using the 44/0/150 stem, those including a 35.5/125 stem, and constructs using any other Exeter V40 stem.ResultsIn all 328,737 THAs using an Exeter V40 stem, the revision estimate was 2.8% (95% confidence interval (CI) 2.7 to 2.8). The 44/00/125 stem was implanted in 2,158 primary THAs, and the ten-year revision estimate was 4.9% (95% CI 3.6 to 6.8). Controlling for age, sex, year of operation, indication, and American Society of Anesthesiologists grade demonstrated an increased overall hazard of revision for constructs using the 44/00/125 stem compared to constructs using other Exeter V40 femoral stems (hazard ratio 1.8 (95% CI 1.4 to 2.3)).ConclusionAlthough the revision estimate is within the National Institute for Health and Care Excellence ten-year benchmark, survivorship of constructs using the 44/00/125 stem appears to be lower than the rest of the range. Adjusted analyses will not take into account ‘confounding by indication’, e.g. patients with complex anatomy who may have a higher risk of revision. Surgeons and patients should be reassured but be aware of the observed increased revision estimate, and only use this stem when other implants are not suitable.Cite this article: Bone Joint J 2023;105-B(5):504–510.

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Section: Discussionmentioning

confidence: 99%

Survival of the Exeter V40 short revision (44/00/125) stem when used in primary total hip arthroplasty

et al. 2023

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“…They also identified 657 THAs that underwent/used a number 1 short stem (125 mm) with a 37.5 mm or greater offset and found no difference in survival compared to the standard stem at a mean follow-up of one year with no stem failures reported. Martin et al [ 12 ] assessed the survival of the number 1 short stem (37.5 mm or greater offset) Exeter ® for up to 3 years in 60 patients undergoing primary THA and reported that no stem had been revised or failed. The current study supports the findings of both studies and affirms the equivocal survival at a longer follow-up of 5- years.…”

Section: Discussionmentioning

confidence: 99%

“…Wyatt et al [ 11 ] demonstrated a greater revision risk associated with the Exeter ® short stem with an offset of less than 37.5 mm for THA, but no difference was observed for short stems of 37.5 mm or more at a maximum of 3 years follow-up, using data from the New Zealand Arthroplasty registry. Martin et al [ 12 ] reported a case series of 60 patients undergoing THA with an Exeter ® short stem of 37.5mm or more at a maximum of 3 years follow-up and reported no revisions of the stem. Therefore, there are limited data reporting the survival of the Exeter ® short stem, especially the recent short stem number 1 implants with a 37.5 mm or more offset, when used as part of a THA.…”

Section: Introductionmentioning

confidence: 99%

Standard versus short stem cemented Exeter® when used for primary total hip arthroplasty: a survivorship analysis

Clement,

Yapp,

Baxendale-Smith

et al. 2023

Arthroplasty

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Aims The aims were to compare the survival of the cemented standard (150 mm) with the short (DDH [35.5 mm offset or less], number 1 short stem [125 mm options of 37.5 mm, 44 mm, 50 mm offset] and revision [44/00/125]) Exeter® V40 femoral stems when used for primary total hip arthroplasty (THA). Methods Patients were retrospectively identified from an arthroplasty database. A total of 664 short stem Exeter® variants were identified, of which 229 were DDH stems, 208 number 1 stems and 227 revision stems were implanted between 2011 and 2020. A control group of 698 standard Exeter® stems used for THA was set up, and were followed up for a minimum of 10 years follow-up (implanted 2011). All-cause survival was assessed for THA and for the stem only. Adjusted analysis was undertaken for age, sex and ASA grade. Results The median survival time for the short stems varied according to design: DDH had a survival time of 6.7 years, number 1 stems 4.1 years, and revision stems 7.2 years. Subjects in the short stem group (n = 664) were significantly younger (mean difference 5.1, P < 0.001) and were more likely to be female (odds ratio 1.89, 95% CI 1.50 to 2.39, P < 0.001), compared to the standard group. There were no differences in THA (P = 0.26) or stem (P = 0.35) survival at 5 years (adjusted THA: 98.3% vs. 97.2%; stem 98.7% vs. 97.8%) or 10 years (adjusted THA 97.0% vs. 96.0 %; stem 96.7% vs. 96.2%) between standard and short stem groups, respectively. At 5 years no differences were found in THA (DDH: 96.7%, number 1 97.5%, revision 97.3%, standard 98.6%) or stem (DDH: 97.6%, number 1 99.0%, revision 97.3%, standard 98.2%) survival between/among the different short stems or when compared to the standard group. Conclusion The Exeter® short stems offer equivocal survival when compared to the standard stem at 5- to 10-year follow-up, which does not seem to be influenced by the short stem design.

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Equivalent revision rates and patient reported outcomes with routine use of a short (125mm) cemented stem for total hip arthroplasty compared to a standard length (150mm) cemented stem. A two surgeon series of 1335 patients

Boyle,

Kuperus,

Maheno

et al. 2024

Arch Orthop Trauma Surg

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Clinical evaluation of the cemented Exeter Short 125 mm stem at a minimum of 3 years: A prospective cohort study

Cited by 5 publications

References 17 publications

Survival of the Exeter V40 short revision (44/00/125) stem when used in primary total hip arthroplasty

Survival of the Exeter V40 short revision (44/00/125) stem when used in primary total hip arthroplasty

Standard versus short stem cemented Exeter® when used for primary total hip arthroplasty: a survivorship analysis

Equivalent revision rates and patient reported outcomes with routine use of a short (125mm) cemented stem for total hip arthroplasty compared to a standard length (150mm) cemented stem. A two surgeon series of 1335 patients

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