The long-term results of the original Exeter polished cemented femoral component: a follow-up report.

We present a long-term follow-up report of the results of the original Exeter polished cemented stems inserted between November 1970 and the end of 1975 at our institution by surgeons of widely differing experience using crude cementing techniques. The results of this series were reported in 1988 (Fowler et al. Orthopaedic Clinics of North America. 1988;19:477) and again in 1993 (Timperley et al. Journal of Bone and Joint Surgery. 1993;75-B:33). There have been no failures from aseptic femoral component loosening since the 1993 report. From the original series of 433 hips, there were, at the end of 2003, 26 living patients with 33 hips. Of the latter, there were 25 hips in 20 patients with their original femoral components still in situ. Twenty-eight (6.46%) hips from the original series have been lost to follow-up, although none since 1992. With the end point reoperation for aseptic stem loosening, the survivorship is 93.5% (95% confidence interval, 90.0%-97.0%). The reoperation rate for aseptic femoral component loosening is 3.23% into the 33rd year of follow-up.

The Exeter Universal hip in patients 50 years or younger at 10-17 years' followup.

UNLABELLED: The Exeter Universal hip (Stryker Inc., Newbury, UK) has reported survival rates of 91.74% at 12 years in all patients with reoperation as an endpoint. However, its performance in younger patients has not been fully established. We reviewed survivorship and the clinical and radiographic outcomes of this hip system implanted in 107 patients (130 hips) 50 years old or younger at the time of surgery. The mean age at surgery was 42 years. The minimum followup was 10 years (mean, 12.5 years; range, 10-17 years) with no patients lost to followup. Twelve hips had been revised. Of these, nine had aseptic loosening of the acetabular component and one cup was revised for focal lysis and pain. One hip was revised for recurrent dislocation and one joint underwent revision for infection. Radiographs demonstrated 14 (12.8%) of the remaining acetabular prostheses were loose but no femoral components were loose. Survivorship of both stem and cup from all causes was 92.6% at an average of 12.5 years. Survivorship of the stem from all causes was 99% and no stem was revised for aseptic loosening. The Exeter Universal stem performed well, even in the young, high-demand patient. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

The initial stability of an exeter femoral stem after impaction bone grafting in combination with segmental defect reconstruction.

Bone impaction grafting of the femur is associated with more complications when segmental defects are present. The effect of segmental defect repair on initial stem stability was studied in an in vitro study with fresh-frozen goat femora. A standardized medial segmental defect was reconstructed using a cortical strut or a metal mesh. As controls, we used intact femora and femora with a nonreconstructed defect. In all 4 groups, impacted bone grafting was performed in combination with a cemented Exeter stem. Each group contained 5 femora. Reconstructions were dynamically loaded up to 1,500 N. Migration was measured with Roentgen stereophotogrammetric analysis. All cases with a nonreconstructed segmental defect failed into excessive varus rotation. None of the femora with a reconstructed defect failed. Cortical struts and metal meshes were equally effective in creating a stable stem construction (varus rotation, 2.89 +/- 2.27 and 2.27 +/- 0.57, respectively). Reconstructions with a metal mesh were more reproducible, although the obtained stability was significantly lower (P<.01) when compared with impaction grafting in an intact femur (varus rotation, 0.58 +/- 0.36).