Experience with primary exeter total hip arthroplasty in patients with small femurs

Chiu, Ka Lok; Wang, Shen; Tsui, Hon For; Chan, Kai-Ming

doi:10.1016/s0883-5403(97)90022-x

Cited by 16 publications

(4 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The literature search yielded 5,290 hits, and 49 studies were included, involving a total of 38,013 acetabular cups; see Figure 1 (Howie et al 1990, Partio et al 1994, Latimer et al 1996, Woolson et al 1996, Chiu et al 1997, Furnes et al 1997, Tompkins et al 1997, Bohm and Bosche 1998, D’Lima et al 1998, Kesteris et al 1998, Callaghan et al 1999, Petersen et al 1999, Ragab et al 1999, Thanner et al 1999, Garellick et al 2000, Ricci et al 2000, Archibeck et al 2001, Oosterbos et al 2001, Espehaug et al 2002, Rogers et al 2003, Duffy et al 2004, Fink et al 2004, Herrera et al 2004, Parvizi et al 2004, Sinha et al 2004, Ender et al 2005, Min et al 2005, Badhe and Livesley 2006, Eskelinen et al 2006, Castoldi et al 2007, Firestone et al 2007, Gjengedal et al 2007, Hing et al 2007, Ince et al 2007, Surdam et al 2007, D’Angelo et al 2008, Gallo et al 2008, Garcia-Rey et al 2008, Heilpern et al 2008, Makela et al 2008, McBryde et al 2008, Steffen et al 2008, Williams et al 2008). The mean AQUILA methodological quality score of the survival studies was 7.3 (SD 1.1) on an 11-point scale.…”

Section: Resultsmentioning

confidence: 99%

Early proximal migration of cups is associated with late revision in THA

et al. 2012

View full text Add to dashboard Cite

Background and purpose The association between excessive early migration of acetabular cups and late aseptic revision has been scantily reported. We therefore performed 2 parallel systematic reviews and meta-analyses to determine the association between early migration of acetabular cups and late aseptic revision.Methods One review covered early migration data from radiostereometric analysis (RSA) studies, while the other focused on revision rates for aseptic loosening from long-term survival studies. Thresholds for acceptable and unacceptable migration were classified according the Swedish Hip Arthroplasty Register and the Australian National Joint Replacement Registry: < 5% revision at 10 years.Results Following an elaborate literature search, 26 studies (involving 700 cups) were included in the RSA review and 49 studies (involving 38,013 cups) were included in the survival review. For every mm increase in 2-year proximal migration, there was a 10% increase in revision rate, which remained after correction for age, sex, diagnosis, hospital type, continent, and study quality. Consequently, proximal migration of up to 0.2 mm was considered acceptable and proximal migration of 1.0 mm or more was considered unacceptable. Cups with proximal migration of between 0.2 and 1.0 mm were considered to be at risk of having revision rates higher than 5% at 10 years.Interpretation There was a clinically relevant association between early migration of acetabular cups and late revision due to loosening. The proposed migration thresholds can be implemented in a phased evidence-based introduction, since they allow early detection of high-risk cups while exposing a small number of patients.

show abstract

Section: Resultsmentioning

confidence: 99%

Early proximal migration of cups is associated with late revision in THA

et al. 2012

View full text Add to dashboard Cite

show abstract

“…[31][32][33] Incomplete cement mantles can occur from oversizing of the stems. Chiu et al 34 from their experience with the Exeter stem in Chinese patients with small femora, showed that there was early loosening in a population in which oversizing of the stem was common, with a resultant incomplete cement mantle and high rates of failure. These incomplete mantles can be avoided by downsizing the implant from the last broach used as long as there are adequate smaller sizes available to allow this.…”

Section: Discussionmentioning

confidence: 99%

The Exeter Universal stem

Hook

Moulder

Yates

et al. 2006

The Journal of Bone and Joint Surgery. British volume

View full text Add to dashboard Cite

We reviewed 142 consecutive primary total hip replacements implanted into 123 patients between 1988 and 1993 using the Exeter Universal femoral stem. A total of 74 patients (88 hips) had survived for ten years or more and were reviewed at a mean of 12.7 years (10 to 17). There was no loss to follow-up. The rate of revision of the femoral component for aseptic loosening and osteolysis was 1.1% (1 stem), that for revision for any cause was 2.2% (2 stems), and for re-operation for any cause was 21.6% (19 hips). Re-operation was because of failure of the acetabular component in all but two hips. All but one femoral component subsided within the cement mantle to a mean of 1.52 mm (0 to 8.3) at the final follow-up. One further stem had subsided excessively (8 mm) and had lucent lines at the cement-stem and cement-bone interfaces. This was classified as a radiological failure and is awaiting revision. One stem was revised for deep infection and one for excessive peri-articular osteolysis. Defects of the cement mantle (Barrack grade C and D) were found in 28% of stems (25 hips), associated with increased subsidence (p = 0.01), but were not associated with endosteal lysis or failure. Peri-articular osteolysis was significantly related to the degree of polyethylene wear (p < 0.001), which was in turn associated with a younger age (p = 0.01) and male gender (p < 0.001). The use of the Exeter metal-backed acetabular component was a notable failure with 12 of 32 hips (37.5%) revised for loosening. The Harris-Galante components failed with excessive wear, osteolysis and dislocation with 15% revised (5 of 33 hips). Only one of 23 hips with a cemented Elite component (4%) was revised for loosening and osteolysis. Our findings show that the Exeter Universal stem implanted outside the originating centre has excellent medium-term results.

show abstract

“…For Thai patients, the problems of mismatching still remain although the small size of Caucasian based prostheses designs were used [3]. Problems from improper size and shape of femoral stem prostheses were found, for example, incomplete cement mantle might be a cause for early loosening [4,5] and long term complications such as aseptic loosening [6]. For these reasons, a specific design for Thai patients is vital and new design must consider the issues of longevity and functionality.…”

Section: Introductionmentioning

confidence: 99%