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Journal of Bone and Joint Surgery - British Volume, Vol 88-B, Issue 12,
1584-1590.
doi: 10.1302/0301-620X.88B12.18345 Copyright © 2006 by British Editorial Society of Bone and Joint Surgery The Exeter Universal stemA MINIMUM TEN-YEAR REVIEW FROM AN INDEPENDENT CENTRES. Hook, MRCS, Specialist Registrar1; E. Moulder, MRCS, Specialist Registrar1; P. J. Yates, MBBS(Hons), BSc (Hons), MRCS, FRCS(Trauma & Orth), Orthopaedic Consultant and Senior Lecturer2; B. J. Burston, MB ChB(Hons), MRCS, Specialist Registrar1; E. Whitley, PhD, MSc, BSc(Hons), Medical Statistician1; and G. C. Bannister, MD, MCh(Orth), FRCS, FRCS Ed(Orth), Consultant Orthopaedic Surgeon1
1 Avon Orthopaedic Centre, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK. Correspondence should be sent to Mr P. J. Yates; e-mail: piersyates{at}hotmail.com
We reviewed 142 consecutive primary total hip replacements implanted into 123 patients between 1988 and 1993 using the Exeter Universal femoral stem. A total of 74 patients (88 hips) had survived for ten years or more and were reviewed at a mean of 12.7 years (10 to 17). There was no loss to follow-up. The rate of revision of the femoral component for aseptic loosening and osteolysis was 1.1% (1 stem), that for revision for any cause was 2.2% (2 stems), and for re-operation for any cause was 21.6% (19 hips). Re-operation was because of failure of the acetabular component in all but two hips. All but one femoral component subsided within the cement mantle to a mean of 1.52 mm (0 to 8.3) at the final follow-up. One further stem had subsided excessively (8 mm) and had lucent lines at the cement-stem and cement-bone interfaces. This was classified as a radiological failure and is awaiting revision. One stem was revised for deep infection and one for excessive peri-articular osteolysis. Defects of the cement mantle (Barrack grade C and D) were found in 28% of stems (25 hips), associated with increased subsidence (p = 0.01), but were not associated with endosteal lysis or failure. Peri-articular osteolysis was significantly related to the degree of polyethylene wear (p < 0.001), which was in turn associated with a younger age (p = 0.01) and male gender (p < 0.001). The use of the Exeter metal-backed acetabular component was a notable failure with 12 of 32 hips (37.5%) revised for loosening. The Harris-Galante components failed with excessive wear, osteolysis and dislocation with 15% revised (5 of 33 hips). Only one of 23 hips with a cemented Elite component (4%) was revised for loosening and osteolysis. Our findings show that the Exeter Universal stem implanted outside the originating centre has excellent medium-term results. This article has been cited by other articles:
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