Survivorship and functional outcome of a cemented acetabular component with bulk roof autograft for severe acetabular dysplasia: 12- to 23-year follow-up

Standard versus short stem cemented Exeter® when used for primary total hip arthroplasty: a survivorship analysis

AIMS

The aims were to compare the survival of the cemented standard (150 mm) with the short (DDH [35.5 mm offset or less], number 1 short stem [125 mm options of 37.5 mm, 44 mm, 50 mm offset] and revision [44/00/125]) Exeter® V40 femoral stems when used for primary total hip arthroplasty (THA).

METHODS

Patients were retrospectively identified from an arthroplasty database. A total of 664 short stem Exeter® variants were identified, of which 229 were DDH stems, 208 number 1 stems and 227 revision stems were implanted between 2011 and 2020. A control group of 698 standard Exeter® stems used for THA was set up, and were followed up for a minimum of 10 years follow-up (implanted 2011). All-cause survival was assessed for THA and for the stem only. Adjusted analysis was undertaken for age, sex and ASA grade.

RESULTS

The median survival time for the short stems varied according to design: DDH had a survival time of 6.7 years, number 1 stems 4.1 years, and revision stems 7.2 years. Subjects in the short stem group (n = 664) were significantly younger (mean difference 5.1, P < 0.001) and were more likely to be female (odds ratio 1.89, 95% CI 1.50 to 2.39, P < 0.001), compared to the standard group. There were no differences in THA (P = 0.26) or stem (P = 0.35) survival at 5 years (adjusted THA: 98.3% vs. 97.2%; stem 98.7% vs. 97.8%) or 10 years (adjusted THA 97.0% vs. 96.0 %; stem 96.7% vs. 96.2%) between standard and short stem groups, respectively. At 5 years no differences were found in THA (DDH: 96.7%, number 1 97.5%, revision 97.3%, standard 98.6%) or stem (DDH: 97.6%, number 1 99.0%, revision 97.3%, standard 98.2%) survival between/among the different short stems or when compared to the standard group.

CONCLUSION

The Exeter® short stems offer equivocal survival when compared to the standard stem at 5- to 10-year follow-up, which does not seem to be influenced by the short stem design.

Femoral head and neck autograft in arthroplasty for developmental dysplasia of the hip: a systematic review of long-term outcomes

PURPOSE

Total hip arthroplasty (THA) with an acetabular component and an autogenous femoral head graft for acetabular reconstruction in developmental dysplasia of the hip was first described by Harris et al. in 1977. While a number of studies have addressed the aforementioned scenario over the last decades, most lack sufficient numbers and follow-up. As such, we analyzed long-term outcomes of THAs with femoral autograft for arthrosis secondary to hip dysplasia.

METHODS

A systematic review was performed using a structured PubMed, Web of Science, Ovid MEDLINE, and Cochrane analysis, based on the PRISMA criteria. All original studies from 1977 to 2022 with a mean follow-up of 10 or more years were included. Methodological Index for Nonrandomized Studies (MINORS) were used for quality assessment.

RESULTS

A total of 26 studies with 1316 patients (87% females) undergoing 1543 THAs with femoral autograft (2 times neck graft, 24 times head graft) were included. Mean age was 52 years (range, 28-73) and the mean follow-up was 13 years (range, 9-18). The revision rate was 8.3% (n = 129), and 73% of revisions were for loosening. Rate of infection (0.5%) and dislocations (1%) were low. Radiographic analysis revealed 167 loose acetabular components (11%) and 118 cases of graft resorption (7.6%). Mean Harris Hip Score increased from 42 to 85. Mean MINORS score was 11, and no study was level of evidence I or II.

CONCLUSIONS

Femoral autograft with THA may be a viable long-term option for hip reconstruction in developmental dysplasia of the hip. However, moderate loosening rates and low level of evidence must be acknowledged before drawing the final conclusions.

LEVEL OF EVIDENCE

Therapeutic Level III.