Analysis of the Exeter V40 femoral stem prosthesis fracture

Thompson, Joshua W.; Corbett, James A.; Bye, Daniel; Jones, Adrian; Tissingh, Elizabeth K; Nolan, John

doi:10.1302/2633-1462.26.bjo-2021-0025.r1

Cited by 12 publications

(6 citation statements)

References 33 publications

(72 reference statements)

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“…By using data from the NJR, they identified 2,158 primary THA employing this implant and found a revision risk that was nearly double that observed with the standard Exeter ® stem at 10-years follow-up [ 10 ]. Periprosthetic fracture was one of the largest contributors to the revision of the SRS stem [ 10 ], which is consistent with the increased risk associated with the collarless polished taper slip design [ 24 , 25 ]. A systematic review by Thompson et al [ 24 ] found 25 reported cases of prosthetic fractures of Exeter ® stems and demonstrated that short (125 mm) stem length was more likely to fracture, and of the seven reported short stems, four were SRS (44/00/125).…”

Section: Discussionmentioning

confidence: 71%

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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Section: Discussionmentioning

confidence: 71%

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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“…Even in two large series, in which the rate of revision surgery due to V40 taper problems was analyzed, a detailed description of ALTR is either lacking or restricted to revised cases. Thompson et al, 39 who found an incidence of 0.15% and 1.21% for taper fractures in 5,370 primary and 662 revision THAs involving Exeter V40 femoral components, did not report follow-up investigations in the patients who did not have a fractured taper. Urish et al 19 reported an incidence of 4.7% of gross trunnion failure and head-neck taper corrosion with LFIT CoCr heads (Stryker) and Accolade TMZF components in 636 patients, but did not perform additional investigations in asymptomatic patients.…”

Section: Discussionmentioning

confidence: 99%

The incidence of adverse local tissue reaction due to head taper corrosion after total hip arthroplasty using V40 taper and 36 mm CoCr head

Grothe

Günther

Hartmann

et al. 2022

The Bone & Joint Journal

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Aims Head-taper corrosion is a cause of failure in total hip arthroplasty (THA). Recent reports have described an increasing number of V40 taper failures with adverse local tissue reaction (ALTR). However, the real incidence of V40 taper damage and its cause remain unknown. The aim of this study was to evaluate the long-term incidence of ALTR in a consecutive series of THAs using a V40 taper and identify potentially related factors. Methods Between January 2006 and June 2007, a total of 121 patients underwent THA using either an uncemented (Accolade I, made of Ti12Mo6Zr2Fe; Stryker, USA) or a cemented (ABG II, made of cobalt-chrome-molybdenum (CoCrMo); Stryker) femoral component, both with a V40 taper (Stryker). Uncemented acetabular components (Trident; Stryker) with crosslinked polyethylene liners and CoCr femoral heads of 36 mm diameter were used in all patients. At a mean folllow-up of 10.8 years (SD 1.1), 94 patients (79%) were eligible for follow-up (six patients had already undergone a revision, 15 had died, and six were lost to follow-up). A total of 85 THAs in 80 patients (mean age 61 years (24 to 75); 47 (56%) were female) underwent clinical and radiological evaluation, including the measurement of whole blood levels of cobalt and chrome. Metal artifact reduction sequence MRI scans of the hip were performed in 71 patients. Results A total of 20 ALTRs were identified on MRI, with an incidence of 26%. Patients with ALTR had significantly higher median Co levels compared with those without ALTR (2.96 μg/l (interquartile range (IQR) 1.35 to 4.98) vs 1.44 μg/l (IQR 0.79 to 2.5); p = 0.019). Radiological evidence of osteolysis was also significantly associated with ALTR (p = 0.014). Median Cr levels were not significantly higher in those with ALTR compared with those without one (0.97 μg/l (IQR 0.72 to 1.9) v 0.67 μg/l (IQR 0.5 to 1.19; p = 0.080). BMI, sex, age, type of femoral component, head length, the inclination of the acetabular component, and heterotopic ossification formation showed no significant relationship with ALTR. Conclusion Due to the high incidence of local ALTR in our cohort after more than ten years postoperatively, we recommend regular follow-up investigation even in asymptomatic patients with V40 taper and metal heads. As cobalt levels correlate with ALTR occurrence, routine metal ion screening and consecutive MRI investigation upon elevation could be discussed. Cite this article: Bone Joint J 2022;104-B(7):852–858.

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“…Thompson et al. found the short Exeter stems had a higher rate of fracture than the standard Exeter stems in their unit (1.25% vs 0.15%) [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

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

McCarthy¹,

Moore²,

Tiedt³

et al. 2023

Arthroplasty Today

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Analysis of the Exeter V40 femoral stem prosthesis fracture

Cited by 12 publications

References 33 publications

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

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

The incidence of adverse local tissue reaction due to head taper corrosion after total hip arthroplasty using V40 taper and 36 mm CoCr head

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

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