Not all cemented hips are the same: a register-based (NJR) comparison of taper-slip and composite beam femoral stems

Kazi, Hussain; Whitehouse, Sarah L.; Howell, Jonathan; Timperley, A. John

doi:10.1080/17453674.2019.1582680

Cited by 40 publications

(44 citation statements)

References 27 publications

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“…Patients had a prospective follow-up including radiographs (pelvis with the patient in supine position centred on the symphysis and a false profile view) after 1 week, 3, 12, 24 and 60 months. Mean age at surgery was 79 (SD 6) years; mean BMI was 25.4 (SD 4.8) kg/m 2 . Mean duration of surgery was 124 (SD 23) min.…”

Section: Methodsmentioning

confidence: 99%

Five-year prospective subsidence analysis of 100 cemented polished straight stems: A concise clinical and radiological follow-up observation

et al. 2019

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Early subsidence (>1.5mm) has been shown to be an indicator for later aseptic loosening of cemented hip stems. For the cemented twinSys® stem we published excellent short-term results at 2 years. Midterm data for this stem are available from national registers (NZL, NL), however in all of these sources, clinical and radiological results are missing. Aim of our study was to analyse mid-term survival and radiological changes around the cemented twinSys®stem with special emphasis on subsidence using EBRA-FCA. We conducted a prospective clinical and radiological 5-year follow-up study of 100 consecutive hybrid total hip arthroplasties (THA) using a polished, cemented collarless straight stem (twinSys®, Mathys AG®Bettlach, Switzerland) with a cementless monobloc pressfit cup (RM pressfit®, Mathys AG® Bettlach, Switzerland). Median age at surgery was 79 (69 to 93) years. No patient was lost to follow-up. Survival rates were calculated using the Kaplan-Meier method. Clinical (Harris Hip Score [HHS]) and radiological (cementing quality, alignment, osteolysis, debonding and cortical atrophy) outcomes and an in-depth subsidence analysis using EBRA-FCA were performed. 22 patients died in the course of follow-up unrelated to surgery, 21 stems had an incomplete radiological follow-up. 2 stems were revised, both due to an infection. The survival rate for the stem at 5 years was 98.0% (95% CI 95.3-100%). The survival rate of the stem for revision due to aseptic loosening at 5 years was 100%. The HHS improved from 53 (14-86) points preoperatively to 90 (49-100) points 5 years after surgery. Osteolysis was found in 2 stems without clinical symptoms. In 49 out of 55 patients with a complete radiological follow-up, the EBRA-FCA analysis was possible and showed an average subsidence of 0.66 (95% CI 0.46 to 0.86) mm 5 years after surgery. 10 patients showed a subsidence >1 mm, 5 of which bigger than 1.5 mm. Subsidence was independent from radiological changes and cementing quality. The cemented twinSys® stem showed excellent clinical and radiological mid-term results at five years’ follow-up and seems to be a reliable implant.

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Section: Methodsmentioning

confidence: 99%

Five-year prospective subsidence analysis of 100 cemented polished straight stems: A concise clinical and radiological follow-up observation

et al. 2019

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“…8 Previous registry-based analysis has demonstrated a statistically and clinically significant survival advantage over all other stems. 9 …”

Section: Discussionmentioning

confidence: 99%

“…The Exeter V40 is one of the most widely used arthroplasty components in current practice – it is the current market leader in the UK National Joint Registry (NJR), accounting for 60% of all stems, and has demonstrated a statistically and clinically significant survival advantage over all other stems in previous registry-based analysis. 8 , 9 …”

Section: Introductionmentioning

confidence: 99%

Outcomes of the Exeter V40 cemented femoral stem at a minimum of ten years in a non-designer centre

et al. 2020

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Aims The Exeter V40 cemented femoral stem was first introduced in 2000. The largest single-centre analysis of this implant to date was published in 2018 by Westerman et al. Excellent results were reported at a minimum of ten years for the first 540 cases performed at the designer centre in the Exeter NHS Trust, with stem survivorship of 96.8%. The aim of this current study is to report long-term outcomes and survivorship for the Exeter V40 stem in a non-designer centre. Methods All patients undergoing primary total hip arthroplasty using the Exeter V40 femoral stem between 1 January 2005 and 31 January 2010 were eligible for inclusion. Data were collected prospectively, with routine follow-up at six to 12 months, two years, five years, and ten years. Functional outcomes were assessed using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. Outcome measures included data on all components in situ beyond ten years, death occurring within ten years with components in situ, and all-cause revision surgery. Results A total of 829 stems in 745 patients were included in the dataset; 155 patients (20.8%) died within ten years, and of the remaining 664 stems, 648 stems (97.6%) remained in situ beyond ten years. For the 21 patients (2.5%) undergoing revision surgery, 16 femoral stems (1.9%) were revised and 18 acetabular components (2.2%) were revised. Indications for revision in order of decreasing frequency were infection (n = 6), pain (n = 6), aseptic component loosening (n = 3), periprosthetic fracture (n = 3), recurrent dislocation (n = 2), and noise production (ceramic-on-ceramic squeak) (n = 1). One patient was revised for aseptic stem loosening. The mean preoperative WOMAC score was 61 (SD 15.9) with a mean postoperative score of 20.4 (SD 19.3) (n = 732; 88.3%). Conclusion The Exeter V40 cemented femoral stem demonstrates excellent functional outcomes and survival when used in a high volume non-designer centre. Outcomes are comparable to those of its serially validated predecessor, the Exeter Universal stem. Cite this article: Bone Jt Open 2020;1-12:743–748.

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“…The Exeter stem has proved to be reliable with good longterm results in elective hip surgery [37]. The low numbers of aseptic loosening of tapered stems might decrease the risk for late periprosthetic fractures.…”

Section: Discussionmentioning

confidence: 99%

Increased risk for postoperative periprosthetic fracture in hip fracture patients with the Exeter stem than the anatomic SP2 Lubinus stem

Mellner

Mohammed

Larsson

et al. 2019

Eur J Trauma Emerg Surg

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Background The purpose of this study was to compare the cumulative incidence of postoperative periprosthetic fracture (PPF) in a cohort of femoral neck fracture (FNF) patients treated with two commonly used cemented stems: either a collarless, polished, tapered Exeter stem or the anatomic Lubinus SP2 stem. Methods In this retrospective multicenter cohort study of a consecutive series of patients, we included 2528 patients of age 60 years and above with an FNF who were treated with either hemiarthroplasty or total hip arthroplasty using either a polished tapered Exeter stem or an anatomic Lubinus SP2 stem. The incidence of PPF was assessed at a minimum of 2 years postoperatively. Results The incidence of PPF was assessed at a median follow-up of 47 months postoperatively. Thirty nine patients (1.5%) sustained a PPF at a median of 27 months (range 0-96 months) postoperatively. Two of the operatively treated fractures were Vancouver A (5%), 7 were Vancouver B1 (18%), 10 were Vancouver B2 (26%), 7 were Vancouver B3 (18%), and 13 were Vancouver C (32%). The cumulative incidence of PPF was 2.3% in the Exeter group compared with 0.7% in the SP2 group (p < 0.001). The HR was 5.4 (95% CI 2.4-12.5, p < 0.001), using the SP2 group as the denominator. Conclusions The Exeter stem was associated with a higher risk for PPF than the Lubinus SP2 stem. We suggest that the tapered Exeter stem should be used with caution in the treatment of FNF. Trial registration The study was registered at clinicaltrials.gov (identifier: NCT03326271).

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Not all cemented hips are the same: a register-based (NJR) comparison of taper-slip and composite beam femoral stems

Cited by 40 publications

References 27 publications

Five-year prospective subsidence analysis of 100 cemented polished straight stems: A concise clinical and radiological follow-up observation

Five-year prospective subsidence analysis of 100 cemented polished straight stems: A concise clinical and radiological follow-up observation

Outcomes of the Exeter V40 cemented femoral stem at a minimum of ten years in a non-designer centre

Increased risk for postoperative periprosthetic fracture in hip fracture patients with the Exeter stem than the anatomic SP2 Lubinus stem

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