1
|
Rocos B, Whitehouse MR. What is the Optimum Pattern of Pressurisation to Gain Maximum Penetration of Methylmethacrylate Cement into the Reamed Acetabulum? Cureus 2020; 12:e6654. [PMID: 32082954 PMCID: PMC7017929 DOI: 10.7759/cureus.6654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction The cemented polyethylene cup has remained the standard acetabular implant for 50 years although there has been little research into cementing techniques. In the past, cement was previously inserted by sequential manual pressurisation (thumbing) but this technique was prone to contamination of the cement leading to weakening of fixation. In recent times, third-generation techniques using sealed pressurisation with rim preparation have been espoused with similar results. We were interested in establishing whether repeated cycles of compression of cement allowing adequate time for relaxation increases its depth of penetration, and the optimum period of relaxation required to achieve this goal. Method A single mix of polymethylmethacrylate cement at dough stage was inserted into a model of the reamed acetabulum. Cyclical pressurisation of the cement with 50 N followed nine different patterns to simulate thumbing, constant pressure, and the application of a sealed and unsealed acetabular cup implant. Results A constant load was as effective as all variations of repeated cycles of load and relaxation except for 50 N pressure applied for four seconds with four second intervals. A four second interval of relaxation achieved significantly more penetration than five or three seconds. Following two minutes of constant pressure, the application of a sealed or unsealed thrust of the plunger had no effect on cement penetration. Conclusion This study suggests that optimal polymethylmethacrylate cement penetration into the acetabulum occurs with cycled application of load for four seconds followed by four seconds of relaxation. The subsequent pressurisation with either a flanged or unflanged acetabular implant does not appear to improve cement penetration.
Collapse
Affiliation(s)
- Brett Rocos
- Orthopaedics, North Bristol National Health Service Trust, Bristol, GBR
| | | |
Collapse
|
2
|
Garala K, Boutefnouchet T, Amblawaner K, Chahal G, Lawrence T. Acetabular Subchondral Bone Decortication and Its Role in the Outcome of Cemented Total Hip Replacement in Young Patients. Hip Pelvis 2018; 30:182-189. [PMID: 30202753 PMCID: PMC6123503 DOI: 10.5371/hp.2018.30.3.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 11/27/2022] Open
Abstract
Purpose Long-term fixation of cemented acetabular components can be problematic in younger active patients. Our technique is put forward to improve outcomes and maximize implant survivorship in this particular patient population. Materials and Methods We report on a cohort of young adult patients (less than 55 years old) with cemented total hip replacement (THR) using a novel technique in preparing and cementing the acetabulum with a minimum follow-up of 10 years (mean follow-up, 14 years). Retrospectively collected data on clinical and radiological outcomes were reviewed. Results Sixty-five THRs were performed with the minimum study follow-up period. Average age for patients was 44 years old (range, 19–55 years). The mean Hip Disability and Osteoarthritis Outcome Score for patients at final appointment was 92.7. Radiographs taken at an average of 14 years after operation showed 63 of 65 hips showed no evidence of any radiological loosening. Cup survivorship was 100% at the end of the study period. Conclusion Our technique of preparing the acetabulum in combination with cement fixation is reproducible with excellent results in a cohort of patients prone to early aseptic loosening of the acetabular component.
Collapse
Affiliation(s)
- Kanai Garala
- Department of Trauma and Orthopaedic Surgery, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Tarek Boutefnouchet
- Department of Trauma of Orthopaedic Surgery, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | | | - Gurdip Chahal
- Department of Trauma of Orthopaedic Surgery, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Trevor Lawrence
- Department of Trauma and Orthopaedic Surgery, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| |
Collapse
|
3
|
Petheram TG, Whitehouse SL, Kazi HA, Hubble MJW, Timperley AJ, Wilson MJ, Howell JR. The Exeter Universal cemented femoral stem at 20 to 25 years: A report of 382 hips. Bone Joint J 2017; 98-B:1441-1449. [PMID: 27803218 DOI: 10.1302/0301-620x.98b11.37668] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 07/05/2016] [Indexed: 11/05/2022]
Abstract
AIMS We present a minimum 20-year follow-up study of 382 cemented Exeter Universal total hip arthroplasties (350 patients) operated on at a mean age of 66.3 years (17 to 94). PATIENTS AND METHODS All patients received the same design of femoral component, regardless of the original diagnosis. Previous surgery had been undertaken for 33 hips (8.6%). During the study period 218 patients with 236 hips (62%) died, 42 hips (11%) were revised and 110 hips (29%) in 96 patients were available for review. The acetabular components were varied and some designs are now obsolete, however they were all cemented. RESULTS With an endpoint of revision for aseptic loosening or lysis, survivorship of the stem at 22.8 years was 99.0% (95% confidence interval (CI) 97.0 to 100). One stem was revised 21 years post-operatively in a patient with Gaucher's disease and proximal femoral osteolysis. Survivorship with aseptic loosening or lysis of the acetabular component or stem as the endpoint at 22.8 years was 89.3% (95% CI 84.8 to 93.8). With an endpoint of revision for any reason, overall survivorship was 82.9% (95% CI 77.4 to 88.4) at 22.8 years. Radiological review showed excellent preservation of bone stock at 20 to 25 years, and no impending failures of the stem. CONCLUSION The Exeter femoral stem continues to perform well beyond 20 years. Cite this article: Bone Joint J 2016;98-B:1441-9.
Collapse
Affiliation(s)
- T G Petheram
- The Princess Elizabeth Orthopaedic Centre, Exeter EX2 5DW, UK
| | - S L Whitehouse
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - H A Kazi
- The Princess Elizabeth Orthopaedic Centre, Exeter EX2 5DW, UK
| | - M J W Hubble
- The Princess Elizabeth Orthopaedic Centre, Exeter EX2 5DW, UK
| | - A J Timperley
- The Princess Elizabeth Orthopaedic Centre, Exeter EX2 5DW, UK
| | - M J Wilson
- The Princess Elizabeth Orthopaedic Centre, Exeter EX2 5DW, UK
| | - J R Howell
- The Princess Elizabeth Orthopaedic Centre, Exeter EX2 5DW, UK
| |
Collapse
|
4
|
Baker P, Rankin K, Naisby S, Agni N, Brewster N, Holland J. Progressive radiolucent lines following the implantation of the cemented Rimfit acetabular component in total hip arthroplasty using the rimcutter technique: cause for concern? Bone Joint J 2016; 98-B:313-9. [PMID: 26920955 DOI: 10.1302/0301-620x.98b3.36613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The highly cross-linked polyethylene Exeter RimFit flanged cemented acetabular component was introduced in the United Kingdom in 2010. This study aimed to examine the rates of emergence of radiolucent lines observed when the Rimfit acetabular component was implanted at total hip arthroplasty (THA) using two different techniques: firstly, the 'rimcutter' technique in which the flange sits on a pre-prepared acetabular rim; and secondly, the 'trimmed flange' technique in which the flange is trimmed and the acetabular component is seated inside the rim of the acetabulum. PATIENTS AND METHODS The radiographs of 150 THAs (75 'rimcutter', 75 'trimmed flange') involving this component were evaluated to assess for radiolucencies at the cement/bone interface by three observers. RESULTS Rimfit acetabular components implanted using the rimcutter technique had significantly higher rates of radiolucency than those introduced using the 'trimmed flange' technique one year post-operatively (one zone: 63/75 (84%) vs 17/75 (23%); two zones 42/75 (56%) vs 0/75 (0%); all three zones 17/75 (23%) vs 0/75 (0%):(all p < 0.001). CONCLUSION On the basis of these findings, we have stopped using the 'rimcutter' technique when implanting the Rimfit acetabular component and have reverted to the 'trimmed flange' technique. TAKE HOME MESSAGE Surgeons should be vigilant of the performance of the Rimfit acetabular component when used alongside the rim cutter device due to an observed higher rate of progressive radiolucencies with this combination of component / technique.
Collapse
Affiliation(s)
- P Baker
- South Tees NHS Trust , Marton Rd, Middlesbrough TS4 3BW, UK
| | - K Rankin
- Freeman Hospital, Freeman Rd, Newcastle-Upon-Tyne, NE7 7DN, UK
| | - S Naisby
- Freeman Hospital, Freeman Rd, Newcastle-Upon-Tyne, NE7 7DN, UK
| | - N Agni
- Freeman Hospital,, Freeman Rd, Newcastle-Upon-Tyne, NE7 7DN, UK
| | - N Brewster
- Freeman Hospital, Freeman Rd, Newcastle-Upon-Tyne, NE7 7DN, UK
| | - J Holland
- Freeman Hospital, Freeman Rd, Newcastle-Upon-Tyne, NE7 7DN, UK
| |
Collapse
|
5
|
Clarke A, Pulikottil-Jacob R, Grove A, Freeman K, Mistry H, Tsertsvadze A, Connock M, Court R, Kandala NB, Costa M, Suri G, Metcalfe D, Crowther M, Morrow S, Johnson S, Sutcliffe P. Total hip replacement and surface replacement for the treatment of pain and disability resulting from end-stage arthritis of the hip (review of technology appraisal guidance 2 and 44): systematic review and economic evaluation. Health Technol Assess 2015; 19:1-668, vii-viii. [PMID: 25634033 DOI: 10.3310/hta19100] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Total hip replacement (THR) involves the replacement of a damaged hip joint with an artificial hip prosthesis. Resurfacing arthroplasty (RS) involves replacement of the joint surface of the femoral head with a metal surface covering. OBJECTIVES To undertake clinical effectiveness and cost-effectiveness analysis of different types of THR and RS for the treatment of pain and disability in people with end-stage arthritis of the hip, in particular to compare the clinical effectiveness and cost-effectiveness of (1) different types of primary THR and RS for people in whom both procedures are suitable and (2) different types of primary THR for people who are not suitable for hip RS. DATA SOURCES Electronic databases including MEDLINE, EMBASE, The Cochrane Library, Current Controlled Trials and UK Clinical Research Network (UKCRN) Portfolio Database were searched in December 2012, with searches limited to publications from 2008 and sample sizes of ≥ 100 participants. Reference lists and websites of manufacturers and professional organisations were also screened. REVIEW METHODS Systematic reviews of the literature were undertaken to appraise the clinical effectiveness and cost-effectiveness of different types of THR and RS for people with end-stage arthritis of the hip. Included randomised controlled trials (RCTs) and systematic reviews were data extracted and risk of bias and methodological quality were independently assessed by two reviewers using the Cochrane Collaboration risk of bias tool and the Assessment of Multiple Systematic Reviews (AMSTAR) tool. A Markov multistate model was developed for the economic evaluation of the technologies. Sensitivity analyses stratified by sex and controlled for age were carried out to assess the robustness of the results. RESULTS A total of 2469 records were screened of which 37 were included, representing 16 RCTs and eight systematic reviews. The mean post-THR Harris Hip Score measured at different follow-up times (from 6 months to 10 years) did not differ between THR groups, including between cross-linked polyethylene and traditional polyethylene cup liners (pooled mean difference 2.29, 95% confidence interval -0.88 to 5.45). Five systematic reviews reported evidence on different types of THR (cemented vs. cementless cup fixation and implant articulation materials) but these reviews were inconclusive. Eleven cost-effectiveness studies were included; four provided relevant cost and utility data for the model. Thirty registry studies were included, with no studies reporting better implant survival for RS than for all types of THR. For all analyses, mean costs for RS were higher than those for THR and mean quality-adjusted life-years (QALYs) were lower. The incremental cost-effectiveness ratio for RS was dominated by THR, that is, THR was cheaper and more effective than RS (for a lifetime horizon in the base-case analysis, the incremental cost of RS was £11,284 and the incremental QALYs were -0.0879). For all age and sex groups RS remained clearly dominated by THR. Cost-effectiveness acceptability curves showed that, for all patients, THR was almost 100% cost-effective at any willingness-to-pay level. There were age and sex differences in the populations with different types of THR and variations in revision rates (from 1.6% to 3.5% at 9 years). For the base-case analysis, for all age and sex groups and a lifetime horizon, mean costs for category E (cemented components with a polyethylene-on-ceramic articulation) were slightly lower and mean QALYs for category E were slightly higher than those for all other THR categories in both deterministic and probabilistic analyses. Hence, category E dominated the other four categories. Sensitivity analysis using an age- and sex-adjusted log-normal model demonstrated that, over a lifetime horizon and at a willingness-to-pay threshold of £20,000 per QALY, categories A and E were equally likely (50%) to be cost-effective. LIMITATIONS A large proportion of the included studies were inconclusive because of poor reporting, missing data, inconsistent results and/or great uncertainty in the treatment effect estimates. This warrants cautious interpretation of the findings. The evidence on complications was scarce, which may be because of the absence or rarity of these events or because of under-reporting. The poor reporting meant that it was not possible to explore contextual factors that might have influenced study results and also reduced the applicability of the findings to routine clinical practice in the UK. The scope of the review was limited to evidence published in English in 2008 or later, which could be interpreted as a weakness; however, systematic reviews would provide summary evidence for studies published before 2008. CONCLUSIONS Compared with THR, revision rates for RS were higher, mean costs for RS were higher and mean QALYs gained were lower; RS was dominated by THR. Similar results were obtained in the deterministic and probabilistic analyses and for all age and sex groups THR was almost 100% cost-effective at any willingness-to-pay level. Revision rates for all types of THR were low. Category A THR (cemented components with a polyethylene-on-metal articulation) was more cost-effective for older age groups. However, across all age-sex groups combined, the mean cost for category E THR (cemented components with a polyethylene-on-ceramic articulation) was slightly lower and the mean QALYs gained were slightly higher. Category E therefore dominated the other four categories. Certain types of THR appeared to confer some benefit, including larger femoral head sizes, use of a cemented cup, use of a cross-linked polyethylene cup liner and a ceramic-on-ceramic as opposed to a metal-on-polyethylene articulation. Further RCTs with long-term follow-up are needed. STUDY REGISTRATION This study is registered as PROSPERO CRD42013003924. FUNDING The National Institute for Health Research Health Technology Assessment programme.
Collapse
Affiliation(s)
- Aileen Clarke
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Amy Grove
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | - Karoline Freeman
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | - Hema Mistry
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Martin Connock
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | - Rachel Court
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Matthew Costa
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | - Gaurav Suri
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | - David Metcalfe
- Warwick Orthopaedics, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Michael Crowther
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Sarah Morrow
- Oxford Medical School, University of Oxford, Oxford, UK
| | - Samantha Johnson
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | - Paul Sutcliffe
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| |
Collapse
|
6
|
Flivik G, Kristiansson I, Ryd L. Positive effect of removal of subchondral bone plate for cemented acetabular component fixation in total hip arthroplasty: a randomised RSA study with ten-year follow-up. Bone Joint J 2015; 97-B:35-44. [PMID: 25568411 DOI: 10.1302/0301-620x.97b1.34391] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We hypothesised that the removal of the subchondral bone plate (SCBP) for cemented acetabular component fixation in total hip arthroplasty (THA) offers advantages over retention by improving the cement-bone interface, without jeopardising implant stability. We have previously published two-year follow-up data of a randomised controlled trial (RCT), in which 50 patients with primary osteoarthritis were randomised to either retention or removal of the SCBP. The mean age of the retention group (n = 25, 13 males) was 70.0 years (sd 6.8). The mean age in the removal group (n = 25, 16 males) was 70.3 years (sd 7.9). Now we have followed up the patients at six (retention group, n = 21; removal group, n = 20) and ten years (retention group: n = 17, removal group: n = 18), administering clinical outcome questionnaires and radiostereometric analysis (RSA), and determining the presence of radiolucent lines (RLLs) on conventional radiographs. RSA demonstrated similar translation and rotation patterns up to six years. Between six and ten years, proximal acetabular component migration and changes of inclination were larger in the retention group, although the mean differences did not reach statistical significance. Differences in migration were driven by two patients in the SCBP retention group with extensive migration versus none in the SCBP removal group. The significant difference (p < 0.001) in the development of radiolucent lines in the retention group, previously observed at two years, increased even further during the course of follow-up (p < 0.001). While recognising SCBP removal is a more demanding technique, we conclude that, wherever possible, the SCBP should be removed to improve the cement-bone interface in order to maximise acetabular component stability and longevity.
Collapse
Affiliation(s)
- G Flivik
- Department of Orthopaedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund S-221 85, Sweden
| | - I Kristiansson
- Department of Orthopaedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund S-221 85, Sweden
| | - L Ryd
- Department of Orthopaedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund S-221 85, Sweden
| |
Collapse
|
7
|
Comparison study of the prosthetics interface pressure profile of air splint socket and ICRC polypropylene socket for upper limb prosthetics. Biocybern Biomed Eng 2015. [DOI: 10.1016/j.bbe.2014.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
8
|
Madanat R, Mäkinen TJ, Aro HT, Bragdon C, Malchau H. Adherence of hip and knee arthroplasty studies to RSA standardization guidelines. A systematic review. Acta Orthop 2014; 85:447-55. [PMID: 24954489 PMCID: PMC4164860 DOI: 10.3109/17453674.2014.934187] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Guidelines for standardization of radiostereometry (RSA) of implants were published in 2005 to facilitate comparison of outcomes between various research groups. In this systematic review, we determined how well studies have adhered to these guidelines. METHODS We carried out a literature search to identify all articles published between January 2000 and December 2011 that used RSA in the evaluation of hip or knee prosthesis migration. 2 investigators independently evaluated each of the studies for adherence to the 13 individual guideline items. Since some of the 13 points included more than 1 criterion, studies were assessed on whether each point was fully met, partially met, or not met. RESULTS 153 studies that met our inclusion criteria were identified. 61 of these were published before the guidelines were introduced (2000-2005) and 92 after the guidelines were introduced (2006-2011). The methodological quality of RSA studies clearly improved from 2000 to 2011. None of the studies fully met all 13 guidelines. Nearly half (43) of the studies published after the guidelines demonstrated a high methodological quality and adhered at least partially to 10 of the 13 guidelines, whereas less than one-fifth (11) of the studies published before the guidelines had the same methodological quality. Commonly unaddressed guideline items were related to imaging methodology, determination of precision from double examinations, and also mean error of rigid-body fitting and condition number cutoff levels. INTERPRETATION The guidelines have improved methodological reporting in RSA studies, but adherence to these guidelines is still relatively low. There is a need to update and clarify the guidelines for clinical hip and knee arthroplasty RSA studies.
Collapse
Affiliation(s)
- Rami Madanat
- Helsinki University Central Hospital, Helsinki,Harris Orthopaedic Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Hannu T Aro
- Turku University Hospital and University of Turku, Turku, Finland
| | - Charles Bragdon
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Henrik Malchau
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
9
|
Darmanis SN, Hubble MJW, Howell JR, Whitehouse SL, Timperley AJ. Benefits of using modern cementing techniques in the acetabulum: the Rim Cutter. J Orthop Surg (Hong Kong) 2012; 20:316-21. [PMID: 23255637 DOI: 10.1177/230949901202000310] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To compare radiological records of 90 consecutive patients who underwent cemented total hip arthroplasty (THA) with or without use of the Rim Cutter to prepare the acetabulum. METHODS The acetabulum of 45 patients was prepared using the Rim Cutter, whereas the device was not used in the other 45 patients. Postoperative radiographs were evaluated using a digital templating system to measure (1) the positions of the operated hips with respect to the normal, contralateral hips (the centre of rotation of the socket, the height of the centre of rotation from the teardrop, and lateralisation of the centre of rotation from the teardrop) and (2) the uniformity and width of the cement mantle in the 3 DeLee Charnley acetabular zones, and the number of radiolucencies in these zones. RESULTS The study group showed improved radiological parameters and were closer to the anatomic centre of rotation both vertically (1.5 vs. 3.7 mm, p<0.001) and horizontally (1.8 vs. 4.4 mm, p<0.001) and had consistently thicker and more uniform cement mantles (p<0.001). There were 2 radiolucent lines in the control group but none in the study group. CONCLUSION The Rim Cutter resulted in more accurate placement of the centre of rotation of a cemented prosthetic socket, and produced a thicker, more congruent cement mantle with fewer radiolucent lines.
Collapse
|
10
|
Carrington NC, Sierra RJ, Gie GA, Hubble MJW, Timperley AJ, Howell JR. The Exeter Universal cemented femoral component at 15 to 17 years. ACTA ACUST UNITED AC 2009; 91:730-7. [DOI: 10.1302/0301-620x.91b6.21627] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The first 325 Exeter Universal stems (309 patients) implanted at the originating centre were inserted between March 1988 and February 1990 by a group of surgeons with differing experience. In this report we describe the clinical and radiological results at a mean of 15.7 years (14.7 to 17.3) after operation with no loss to follow-up. There were 97 patients (108 hips) with replacements still in situ and 31 (31 hips) who had undergone a further procedure. With an endpoint of revision for aseptic loosening, the survivorship at 17 years was 100% and 90.4% for the femoral and acetabular component, respectively. The mean Merle D’Aubigné and Postel scores at review were 5.4 (sd 0.97) for pain and 4.5 (sd 1.72) for function. The mean Oxford score was 38.4 (sd 9.8) (0 to 48 worst-to-best scale) and the mean combined Harris pain and function score was 73.2 (sd 16.9). Radiological review showed excellent preservation of bone stock in the proximal femur and no failures of the femoral component.
Collapse
Affiliation(s)
| | - R. J. Sierra
- Department of Orthopaedic Surgery Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - G. A. Gie
- Exeter Hip Unit Princess Elizabeth Orthopaedic Centre, Barrack Road, Exeter, Devon EX2 5DW, UK
| | - M. J. W. Hubble
- Exeter Hip Unit Princess Elizabeth Orthopaedic Centre, Barrack Road, Exeter, Devon EX2 5DW, UK
| | - A. J. Timperley
- Exeter Hip Unit Princess Elizabeth Orthopaedic Centre, Barrack Road, Exeter, Devon EX2 5DW, UK
| | - J. R. Howell
- Exeter Hip Unit Princess Elizabeth Orthopaedic Centre, Barrack Road, Exeter, Devon EX2 5DW, UK
| |
Collapse
|