Results of the cemented Exeter femoral component in patients under the age of 40

Schmitz, M. W. J. L.; Bronsema, E.; Kam, D.C.J. de; Gardeniers, J.W.M.; Veth, R. P. H.; Schreurs, B.W.

doi:10.1302/0301-620x.99b2.38045

Cited by 27 publications

(19 citation statements)

References 41 publications

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“…Despite a growing popularity of cementless stems, cemented stem fixation can still be seen as the benchmark for stem fixation with negligible revision rates in the first decade after THA. [1][2][3][4] Early subsidence of cemented stems is highly predictive for later aseptic failure. Different cut-off values, depending on the means of measurement, are described.…”

Section: Introductionmentioning

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: Introductionmentioning

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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“…Although the popularity of cementless femoral stem fixation continues to rise, cemented femoral fixation still serves as the benchmark, with the risk of mechanical failure of fixation having shown to be negligible in the first decade, 1,2 and periprosthetic fracture having been identified as the main cause for revision in the second decade after implantation. 3 There is universal agreement that implementation of a modern cementing technique is a condition sine qua non , and the quality of cementing technique and the establishment of optimal cement interdigitation and non-deficient cement mantle have been identified to be the most predictive factors for favourable long-term outcome.…”

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confidence: 99%

“…Although various types of cemented stems are in clinical use, with favourable and predictable outcome reported both in small series 2,6,7 and in national registries, 1,5,8 there is still controversy regarding the best and most forgiving stem design (shape and surface) and the optimal cement mantle thickness. 9-11…”

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confidence: 99%

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The ‘French paradox’ may not be a paradox after all – but for what reason?

Clauss

Breusch

2019

Bone & Joint Research

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“…Cemented stems used for primary THA achieve that goal with mechanical failure being negligible in the first decade. 1,2 In revision scenarios however, cancellous bone for cement interdigitation, especially in the metaphysis, is frequently absent. In these cases additional impaction bone grafting may improve implant stability with excellent long-term results, 3,4 but is demanding and associated with a high rate of periprosthetic fractures.…”

Section: Introductionmentioning

confidence: 99%

Is cemented revision total hip arthroplasty a reasonable treatment option in an elderly population?

et al. 2019

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Revision THA is increasingly performed especially in the elderly population. The surgeon’s challenge is to provide a solution that supports immediate full weight-bearing, despite poor bone quality. Shape-closed revision stems facilitate that by combining cement fixation with additional press-fit anchoring. The design tolerates varying cement mantle thickness and inconsistent cancellous bone lining of the femoral canal. Following that philosophy, we present our mid-term results using a long version of a cemented Charnley- Kerboull type stem. From 2010 to 2017, 38 long Charnley-Kerboull revision stems (Centris®, Mathys European Orthopaedics, Bettlach, Switzerland) were implanted and followed prospectively. Surgery was performed via a Hardinge approach in supine position with a third generation cementing technique. Patients were mobilized using full-weight bearing as early as possible. Survival was determined for stem revision for aseptic loosening and stem and/or cup revision for any reason. 20 stems had a minimum follow-up (f/u) of 2 years and were included for further radiological analysis. Detailed subsidence analysis as an early predictor for later aseptic loosening was performed using EBRA-FCA software. Further, the presence of osteolysis and cement debonding was evaluated. Mean follow- up was 4 years. No patient was lost to f/u.18 died of causes unrelated to THA. Stem survival was 100%. Survival for any re-operation was 82.2% (two early infections, one soft-tissue debridement, one cup exchange for recurrent dislocations). None of the cases revised for septic loosening showed signs of persistent infection at final f/u. EBRA-FCA revealed two oligosymptomatic cases of subsidence of 5mm and 6mm over a course of 2 and 12 months, respectively, with stable implants thereafter. Neither required revision. There was no development of osteolysis or debonding. The stem provides a reliable early fullweight bearing solution for revision THA with excellent mid-term survival in an elderly population. Even in two cases where subsidence was present, mobility was not impaired and re-revision could be avoided.

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Results of the cemented Exeter femoral component in patients under the age of 40

Abstract: The Exeter femoral component continues to function satisfactorily in young patients for up to 17 years after surgery. Cite this article: Bone Joint J 2017;99-B:192-8.

Cited by 27 publications

References 41 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

The ‘French paradox’ may not be a paradox after all – but for what reason?

Is cemented revision total hip arthroplasty a reasonable treatment option in an elderly population?

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