First Series of Exeter Small Stem Primary Total Hip Arthroplasty Minimum 5 Years of Follow-Up

The Asian size Exeter femoral stem fracture

“…No stem failure was observed at the time of Chiu's reporting [3,4]. Fujita [20], Sivananthan [21], and Tai [22] from different Asian centers also reported their results of small Exeter stem implanted for primary and revision total hip arthroplasties, with no stem fracture observed. Choy compared the results of Exeter short stems with the standard length Exeter stems from the national joint replacement registry [23].…”

Exeter Small Femoral Stem for Patients with Small Femurs

“…Although the 'Exeter concept' remains controversial, 25,26 clinical and radiographic results indicate that stem subsidence within the cement mantle alone is not a sign of loosening but protects the cement-bone interface. 1,8,23,27 The superior results of a polish-surfaced stem over a matt-surfaced stem has also been reported. [3][4][5][28][29][30][31][32] In a study comparing the subsidence of the Exeter polish-surfaced stem with the Charnley Elite stem (which has a small collar and matt surface), 30 subsidence occurred only at the cement-implant interface in the Exeter polished stem, whereas it occurred at both the cement-implant and cement-bone interfaces for the Charnley Elite stem, although the extent of subsidence was smaller.…”

“…1 The use of small femoral stems avoids intramedullary reaming and provides room for a cement mantle. In a series of Exeter small femoral stems with a mean follow-up of 9 years, 23 the overall survival rate at 10 years was 96% and was 100% for aseptic loosening. There was no implant breakage.…”

The Use of a 3-Dimensional Computed Tomography Bone Database to Evaluate the Risk of Distal Contact between the Rasp Tip and the Endosteal Cortical Bone

“…12 Shorter stems of 95, 105, and 115 mm in length with the respective offset of 30, 33, and 35.5 mm have been developed and have achieved excellent outcome in smaller patients. 4,13 Nonetheless, in patients with a narrower medullary canal and offset of >35.5 mm, restoration of anatomy remains a challenge. The geometry of the proximal femur is determined by genetic and environmental factors that include age, race, sex, and lifestyle.…”

“…In patients with a narrow femoral canal ('champagne flute' or Dorr A type), cortical contact may occur distally with the rasp and this may restrict re-creation of the correct femoral offset with a 150-mm length stem. 4 Shorter Exeter stems (95 to 125 mm) are available with offsets of 30 to 35.5 mm. According to the Australian National Joint Replacement Registry, these shorter stems have achieved excellent survival at 7 years, comparable with 150-mm-length stems.…”