The Exeter Universal stem

Hook, Samantha; Moulder, Elizabeth; Yates, Piers; Burston, Ben; Whitley, Elise; Bannister, G.C.

doi:10.1302/0301-620x.88b12.18345

Cited by 72 publications

(31 citation statements)

References 34 publications

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“…Based on our results combined with the results of long-term follow-up studies (Hook et al 2006, Carrington et al 2009) and reports from the registries (Espehaug et al 2009, Havelin et al 2009), continuous migration appears to be compatible with good long-term survivorship for this (polished, double-tapered, collarless) prosthesis design. However, we do not expect that this finding can be generalized to all femoral stems.…”

Section: Discussionsupporting

confidence: 68%

“…It is interesting to note that this pattern of continuous migration of the femoral component (subsidence and retroversion) has been considered to be a pattern of failure (Kärrholm et al 2000, Hauptfleisch et al 2006, Hook et al 2006). However, the magnitude of the estimated annual migration was very small and we do not consider this migration to be clinically worrisome.…”

Section: Discussionmentioning

confidence: 99%

“…This implies that the prosthesis never reaches a stable position. Nevertheless, the long-term survival of the Exeter stem is good and revision rates are low (Hook et al 2006, Carrington et al 2009, Havelin et al 2009), which suggests that absolute stability may not be required for good survivorship of certain types of implants.…”

mentioning

confidence: 99%

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The Exeter femoral stem continues to migrate during its first decade after implantation

Nieuwenhuijse¹,

Valstar²,

Kaptein³

et al. 2012

Acta Orthopaedica

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Background Due to its collarless, double-tapered polished design, the Exeter femoral stem is known to migrate distally in the first 5 years after implantation. However, its long-term migration pattern has not been investigated.Patients and methods 39 consecutive patients (41 total hip arthroplasties) received a cemented Exeter stem and had prospective clinical and RSA follow-up. Patients were evaluated postoperatively at 6, 12, 26, and 52 weeks, and annually thereafter. Short-term results have been reported. In this study, the mean length of follow-up was 9.4 years (SD 3.2 years). No patients were lost to follow-up. 15 patients died during follow-up.Results No stems were revised. In 4 stems, fractures of the cement mantle were noted within the first 3 postoperative years. In 3 stems, this resulted in a complete circumferential cement mantle discontinuity. For the 37 well-performing stems, continuous but small migration was measured between 2 and 12 years of follow-up. Continued subsidence of 0.08 mm/year (95% CI: 0.05–0.12, p < 0.001) was seen in combination with continued rotation in retroversion of 0.07°/year (95% CI: 0.02–0.12, p = 0.01). At 10 years of follow-up, mean subsidence was 2.1 (SD 1.2) mm and mean retroversion was 1.8° (SD 2.0). Two-thirds of this occurred during the first 2 postoperative years. In the 3 stems with a complete circumferential cement fracture, a sudden and disproportionately high increase in subsidence was measured in the time period of occurrence.Interpretation The Exeter femoral stem continues to migrate during the first decade after implantation. Absolute stability is not required for good long-term survival if this is compatible with the design of the implant.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Exeter femoral stem continues to migrate during its first decade after implantation

Nieuwenhuijse¹,

Valstar²,

Kaptein³

et al. 2012

Acta Orthopaedica

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“…Kaplan–Meier survivorship of the Exeter contemporary flanged cemented acetabular component, at 12.5 years with aseptic loosening as the end point was 100%,56 as was survivorship of the cemented Exeter Universal femoral stem at 17 years 57. Similar results have been reported by other units, both in the UK and internationally 5859…”

Section: Benefits Of Cemented Total Hip Arthroplastysupporting

confidence: 82%

The Relative Merits of Cemented and Uncemented Prostheses in Total Hip Arthroplasty

Maggs

Wilson

2017

IJOO

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“…The most widely used and quoted data for risk of revision come from joint registry reports, but are often limited to 10 years of follow-up 3, 7, 12. Other studies with longer patient follow-up (greater than 20 years) are frequently restricted to specific prostheses or small populations, without specific focus on the results from patients younger than 60 years at implantation 13, 14. Therefore, for these patients, information about implant revision rates tends to be restricted to 10 years, and although worse than those seen for patients older than 60,3, 9, 15 might not truly reflect the risk of revision over the longer timeframe.…”

Section: Introductionmentioning

confidence: 99%

The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study

et al. 2017

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SummaryBackgroundTotal joint replacements for end-stage osteoarthritis of the hip and knee are cost-effective and demonstrate significant clinical improvement. However, robust population based lifetime-risk data for implant revision are not available to aid patient decision making, which is a particular problem in young patient groups deciding on best-timing for surgery.MethodsWe did implant survival analysis on all patients within the Clinical Practice Research Datalink who had undergone total hip replacement or total knee replacement. These data were adjusted for all-cause mortality with data from the Office for National Statistics and used to generate lifetime risks of revision surgery based on increasing age at the time of primary surgery.FindingsWe identified 63 158 patients who had undergone total hip replacement and 54 276 who had total knee replacement between Jan 1, 1991, and Aug 10, 2011, and followed up these patients to a maximum of 20 years. For total hip replacement, 10-year implant survival rate was 95·6% (95% CI 95·3–95·9) and 20-year rate was 85·0% (83·2–86·6). For total knee replacement, 10-year implant survival rate was 96·1% (95·8–96·4), and 20-year implant survival rate was 89·7% (87·5–91·5). The lifetime risk of requiring revision surgery in patients who had total hip replacement or total knee replacement over the age of 70 years was about 5% with no difference between sexes. For those who had surgery younger than 70 years, however, the lifetime risk of revision increased for younger patients, up to 35% (95% CI 30·9–39·1) for men in their early 50s, with large differences seen between male and female patients (15% lower for women in same age group). The median time to revision for patients who had surgery younger than age 60 was 4·4 years.InterpretationOur study used novel methodology to investigate and offer new insight into the importance of young age and risk of revision after total hip or knee replacement. Our evidence challenges the increasing trend for more total hip replacements and total knee replacements to be done in the younger patient group, and these data should be offered to patients as part of the shared decision making process.FundingOxford Musculoskeletal Biomedical Research Unit, National Institute for Health Research.

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The Exeter Universal stem

Cited by 72 publications

References 34 publications

The Exeter femoral stem continues to migrate during its first decade after implantation

The Exeter femoral stem continues to migrate during its first decade after implantation

The Relative Merits of Cemented and Uncemented Prostheses in Total Hip Arthroplasty

The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study

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