The Exeter V40 cemented femoral component at a minimum 10-year follow-up

Westerman, Richard W.; Whitehouse, Sarah L.; Hubble, M; Timperley, A. John; Howell, Jonathan; Wilson, M

doi:10.1302/0301-620x.100b8.bjj-2017-1535.r1

Cited by 43 publications

(59 citation statements)

References 35 publications

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“…2017, Westerman et al. 2018). It is postulated that the subsidence of the Exeter stem into the cement mantle will create an axial loading effect within the cement mantle, resulting in hoop stresses in the adjacent bone, which might increase the risk of sustaining a PPFF.…”

Section: Discussionmentioning

confidence: 99%

“…A difference in stem length can potentially affect the risk of periprosthetic fracture and its classification into type B or C. We also excluded uncemented cups, since use of such implants was shown to result in a higher rate of femoral lysis when used with Exeter V40 stems (Westerman et al. 2018). Furthermore, we investigated all kind of reoperations due to PPFF, and not only revisions, which is the contemporary standard in other arthroplasty registries.…”

Section: Discussionmentioning

confidence: 99%

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The design of the cemented stem influences the risk of Vancouver type B fractures, but not of type C: an analysis of 82,837 Lubinus SPII and Exeter Polished stems

2019

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Background and purpose — In total hip replacements, stem design may affect the occurrence of periprosthetic femoral fracture. We studied risk factors for fractures around and distal to the 2 most used cemented femoral stems in Sweden. Patients and methods — This is a register study including all standard primary Lubinus SPII and Exeter Polished stems operated in Sweden between 2001 and 2009. The outcome was any kind of reoperation due to fracture around (Vancouver type B) or distal to the stem (Vancouver type C), with use of age, sex, diagnosis at primary THR, and year of index operation as covariates in a Cox regression analysis. A separate analysis of the primary osteoarthritis patient group was done in order to evaluate eventual influence of the surgical approach (lateral versus posterior) on the risk for Vancouver type B fractures. Results — The Exeter stem had a 10-times (95% CI 7–13) higher risk for type B fractures, compared with the Lubinus, while no statistically significant difference was noticed for type C fractures. The elderly, and patients with hip fracture or idiopathic femoral head necrosis, had a higher risk for both fracture types. Inflammatory arthritis was a risk factor only for type C fractures. Type B fractures were more common in men, and type C in women. A lateral approach was associated with decreased risk for Type B fracture. Interpretation — Stem design influenced the risk for type B, but not for type C fracture. The influence of surgical approach on the risk for periprosthetic femoral fracture should be studied further.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The design of the cemented stem influences the risk of Vancouver type B fractures, but not of type C: an analysis of 82,837 Lubinus SPII and Exeter Polished stems

2019

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“…The Exeter Universal stem was introduced in 1988 and proved highly successful with the first 325 stems demonstrating 100% survivorship of the femoral component with aseptic femoral loosening as the endpoint [10]. Because there are no published differences of altered survivorship with a change from the Universal to the V40 Exeter stem, we feel that this combination is justified for the purpose of this study [11].…”

Section: Discussionmentioning

confidence: 97%

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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“…Originally, double-tapered polished stems, such as the Exeter stem and the CPT stem, were developed. Their long-term good clinical results have been previously reported [4][5][6], while the bone loss in the calcar region around double-tapered stem was concerning [7]. A triple-tapered cemented stem was designed with the intention of loading the proximal femur, thereby reducing proximal bone loss [8].…”

Section: Introductionmentioning

confidence: 95%

Minimum Ten-Year Outcome of a Triple-Tapered Femoral Stem Implanted With Line-To-Line Cementing Technique

Ohashi

Iida

Izumi

2021

Preprint

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Background A triple-tapered polished femoral stem was implanted with line-to-line cementing technique. The purpose of this study was to determine the survivorship, loosening rate, stem subsidence, radiologic changes and clinical outcomes in the minimum ten-year follow-up. Methods This was a retrospective study done in three institutes. Finally, 118 hips in 97 patients could be followed-up at the mean follow-up period of 126.9 months. The survivorship, radiological and clinical outcomes were investigated. Results Radiologically, 107 hips (90.7%) were categorized to Barrack cementing grade A, and 108 stems (91.5%) were inserted in neutral position. All hips were not loose and were not revised due to aseptic loosening. Survival with revision for any reason as the endpoint was 100% after 10 years. At the last follow-up, the mean subsidence was 0.41 mm, and the subsidence was less than 1 mm in 110 hips (93.2%). JOA hip score improved from 42.7 ± 9.2 points preoperatively to 92.9 ± 6.8 points at the last follow-up. No patient complained thigh pain. Conclusions Line-to-line cementing technique with use of a triple-tapered polished stem was effective to achieve good cementation quality and centralization of the stem. The subsidence was small, and the minimum ten-year results were excellent without any failures related to the stem.Trial registration: Retrospectively registered

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The Exeter V40 cemented femoral component at a minimum 10-year follow-up

Abstract: Conclusion No stem was revised for aseptic loosening in this series. The contemporary Exeter V40 stem continues to perform well, and survival has remained comparable with that of the Exeter Universal stem. Cite this article: Bone Joint J 2018;100-B:1002-9.

Cited by 43 publications

References 35 publications

The design of the cemented stem influences the risk of Vancouver type B fractures, but not of type C: an analysis of 82,837 Lubinus SPII and Exeter Polished stems

The design of the cemented stem influences the risk of Vancouver type B fractures, but not of type C: an analysis of 82,837 Lubinus SPII and Exeter Polished stems

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

Minimum Ten-Year Outcome of a Triple-Tapered Femoral Stem Implanted With Line-To-Line Cementing Technique

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