Exeter Short Stems Compared With Standard Length Exeter Stems

Choy, Godwin; Roe, John; Whitehouse, Sarah L.; Cashman, Kara; Crawford, Ross

doi:10.1016/j.arth.2012.06.016

Cited by 35 publications

(14 citation statements)

References 18 publications

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“…This contrasts the findings of our study where the Standard group had superior survivorship compared with the Short 37À group. The Australian study did not examine the Short 37þ stems [4]. Our study's findings suggest that the Short 37þ stems behave more like Standard stems.…”

Section: Discussioncontrasting

confidence: 54%

“…In the Australian National Joint Registry study at 7 years [4], there was no significant difference in survivorship rates between the Short 37À and Standard groups (3.4% revised; 95% CI: 2.4 to 4.8% vs 3.5%; 95% CI: 3.3 to 3.8%, respectively). This contrasts the findings of our study where the Standard group had superior survivorship compared with the Short 37À group.…”

Section: Discussionmentioning

confidence: 91%

“…1). Despite concerns about insufficient mechanical strength and premature stem breakage in short stems [3], a recent study from the Australian Orthopedic Association National Joint Registry showed that at 7 years, there was no significant difference in survival rates between standardlength Exeter stems and short stems of offsets of 35.5 mm or less [4]. This Australian study, however, did not include data on how the Exeter 125 mm of offsets 37.5 mm, 44 mm, and 50 mm (introduced in 2011) compared in terms of function or survivorship.…”

Section: Introductionmentioning

confidence: 99%

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How do cemented short Exeter stems perform compared with standard-length Exeter stems? The experience of the New Zealand National Joint Registry

et al. 2020

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a b s t r a c tBackground: The standard Exeter (Stryker) cemented stem is 150 mm long with standard offsets ranging from 37.5 mm to 56 mm. Exeter short stems of 125 mm are also available in the offsets of 37.5 mm, 44 mm, and 50 mm. In addition, smaller (125 mm or shorter) Exeter cemented stems with offsets of 35.5 mm or less are available. The aim of this study was to examine the New Zealand Joint Registry (NZJR) comparing medium-term survival rates and functional outcomes of standard-length stems with Exeter short stems of various offsets in patients undergoing primary total hip replacement. Methods: Using the NZJR, we compared the results of 3 separate groups of patients with Exeter stems. Patients with standard 150 mm length Exeter stems (Standard) were compared with patients with Exeter 125 mm stems with regular 37.5 mm, 44 mm, and 50 mm offsets (Short 37þ) and Exeter 125 mm stems with offsets of 35.5 mm and below (Short 37À). Demographic data, preoperative diagnosis, patient-reported outcome measures, and reasons for revision were compared between groups. Kaplan-Meier survival analysis and Cox multivariate regression analysis were used to examine implant survival and the influence of stem group on revision rates adjusting for gender, age, diagnosis, and surgical approach. Short 37 þ groups compared with the Standard group (Standard BMI, 28.71; SD 5.72; Short 37þ BMI, 29.69; SD, 6.67; Short 37À BMI, 29.09; SD 7.07; P < .001). The all-cause revision rate for standard stems was 0.55/100 component years (cy) (95% CI: 0.52 to 0.58). The Short 37À group had a higher rate of revision compared with the Standard group (hazard ratio 1.6; 95% CI: 1.3 to 1.98; P < .001), while the Short 37þ group had a hazard ratio of 0.84 (95% CI: 0.38 to 1.88; P ¼ .674) compared with the Standard group. Cox regression analysis controlling for age, gender, diagnosis of OA, and surgical approach did not affect these findings. However, no clinically meaningful difference between Oxford hip scores was observed. Conclusions: There was a significant difference in revision rates for aseptic loosening with standard-length Exeter stems having a lower revision rate than short Exeter stems with offsets 35.5 mm or less. The Short 37þ groups, despite comprising relatively small numbers, performed similarly to the Standard stem group.

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Section: Discussioncontrasting

confidence: 54%

Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

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How do cemented short Exeter stems perform compared with standard-length Exeter stems? The experience of the New Zealand National Joint Registry

et al. 2020

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“…The geometry and dimensions of the implant were obtained from a standard 37.5- mm-offset Exeter ® cemented prosthesis [ 20 ] with a collarless, smooth, polished, tapered stem positioned in an anatomical neutral orientation of 0° version. Any other implant model can be easily simulated.…”

Section: Methodsmentioning

confidence: 99%

Range of Movement for Impingement and Dislocation Avoidance in Total Hip Replacement Predicted by Finite Element Model

et al. 2017

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Dislocation is a serious complication in total hip replacement (THR). An inadequate range of movement (ROM) can lead to impingement of the prosthesis neck on the acetabular cup; furthermore, the initiation of subluxation and dislocation may occur. The objective of this study was to generate a parametric three-dimensional finite element (FE) model capable of predicting the dislocation stability for various positions of the prosthetic head, neck, and cup under various activities. Three femoral head sizes (28, 32, and 36 mm) were simulated. Nine acetabular placement positions (abduction angles of 25°, 40° and 60° combined with anteversion angles of 0°, 15° and 25°) were analyzed. The ROM and maximum resisting moment (RM) until dislocation were evaluated based on the stress distribution in the acetabulum component. The analysis allowed for the definition of a “safe zone” of movement for impingement and dislocation avoidance in THR: an abduction angle of 40°–60° and anteversion angle of 15°–25°. It is especially critical that the anteversion angle does not fall to 10°–15°. The sequence of the RM is a valid parameter for describing dislocation stability in FE studies.

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“…In primary THA, 2 types of prostheses are available: conventional stems (CSs) and short stems (SSs). CSs are a standard length of ∼150 mm, compared with SSs, [1] which are <120 mm in length. [ 2 3 ] Although excellent survival rates have been reported with conventional femoral stems in THA, [ 4 5 ] proximal stress shielding and thigh pain often occur after THA [3] .…”

Section: Introductionmentioning

confidence: 99%

Short-stem prostheses in primary total hip arthroplasty

et al. 2016

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Background:Short-stem (SS) prostheses require less resection of the femoral neck, produce a more physiological load pattern in the proximal femur, reduce stress shielding, and aid bone conservation and are, therefore, beneficial for young patients. Conventional cementless implants in total hip arthroplasty (THA) have shown excellent clinical results; however, it is unclear whether SS prostheses can obtain the same clinical and radiological outcomes. We conducted a meta-analysis of randomized controlled trials (RCTs) to evaluate whether SS prostheses are superior to conventional implants after primary THA.Methods:We reviewed the literature published up to June 2016 from PubMed, Web of Science, and the Cochrane Library to find relevant RCTs comparing SSs and conventional stems in primary THA. Quality assessment was performed by 2 independent reviewers. The RevMan 5.3 software program of the Cochrane Collaboration was used to analyze the data. Random- or fixed-effect models were used to calculate standardized mean differences (SMDs) and 95% confidence intervals (CIs) for each comparison.Results:Six RCTs involving 552 patients with 572 hips were identified. Strong evidence indicated that SS prostheses were more effective for reducing thigh pain than conventional implants (I 2 = 46%, P = 0.002; risk ratio [RR], 95% CI 0.15, 0.04–0.49). However, there were no significant differences between the 2 groups in Harris Hip Scores (I 2 = 0%, P = 0.84; SMD, 95% CI 0.02, −0.15–0.18), Western Ontario and McMaster Universities Osteoarthritis Index Scores (I 2 = 0%, P = 0.35; SMD, 95% CI 0.09, −0.10–0.27), femoral offset of stem (I 2 = 0%, P = 0.57; SMD, 95% CI 0.06, −0.16–0.29), and leg-length discrepancy (I 2 = 79%, P = 0.88; SMD, 95% CI 0.04, −0.44–0.51).Conclusion:SS prostheses achieve the same clinical and radiological outcomes as conventional implants, and were superior in terms of reducing thigh pain. But whether the postoperative thigh pain applied in 2nd-generation cementless prosthesis still needs further large-scale multicenter studies with longer follow-up to confirm.

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Exeter Short Stems Compared With Standard Length Exeter Stems

Cited by 35 publications

References 18 publications

How do cemented short Exeter stems perform compared with standard-length Exeter stems? The experience of the New Zealand National Joint Registry

How do cemented short Exeter stems perform compared with standard-length Exeter stems? The experience of the New Zealand National Joint Registry

Range of Movement for Impingement and Dislocation Avoidance in Total Hip Replacement Predicted by Finite Element Model

Short-stem prostheses in primary total hip arthroplasty

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