Skip to main content
SpringerLink
Log in

A prospective study of hip revision surgery using the Exeter long-stem prosthesis: function, subsidence, and complications for 57 patients

  • Original Article
  • Published:
Journal of Orthopaedics and Traumatology Submit manuscript

Abstract

Background

The long-stem Exeter femoral component is commonly used in revision hip surgery. Subsidence of the femoral stem in primary hip arthroplasty has been studied extensively, but much less is known about its significance in revision surgery. This prospective study examined the relationship between radiological subsidence, Western Ontario and McMaster (WOMAC) osteoarthritis index pain score, patient satisfaction and complication rates for the long-stem Exeter hip prosthesis.

Materials and methods

Data was prospectively collected for a single-surgeon series of 96 patients undergoing revision surgery with a mean follow-up period of 36 months. Pre- and post-operative clinical evaluation was carried out using the validated WOMAC osteoarthritis index. Radiographic evaluation was carried out on magnification-adjusted digital radiographic images.

Results

Data from 57 patients were analysed. The mean rate of subsidence recorded was 0.43 mm/year, with a mean total subsidence of 0.79 mm [95% confidence interval (CI) 0.57–1.01] at 36.3 months. There was no correlation between subsidence and post-operative WOMAC score, complication rate or patient satisfaction. There was a statistically significant reduction between pre-operative and post-operative WOMAC scores, with means of 33.5 and 10.7, respectively (P < 0.001), and high patient satisfaction.

Conclusion

Our subsidence rates for long-stem revision femoral components are lower than the published data but demonstrate the same plateau. Radiographic subsidence does not appear to relate to functional outcome or complication rates in our data.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Coyte PC, Young W, Williams JI (1998) Devolution of hip and knee replacement surgery? Can J Plast Surg 39(5):373–378

    Google Scholar 

  2. Hungerford DS, Jones LC (1988) The rationale of cementless revision of cemented arthroplasty failures. Clin Orthop Relat Res 235:12–24

    Article  Google Scholar 

  3. Li P, Ingle P, Dowell J (1996) Cement within cement revision hip arthroplasty; should it be done? J Bone Joint Surg Br 78(5):809–811

    Article  CAS  PubMed  Google Scholar 

  4. Mandziak DG, Howie DW et al (2007) Cement-within-cement stem exchange using the collarless polished double-taper stem. J Arthroplasty 22(7):1000–1006

    Article  PubMed  Google Scholar 

  5. D’Lima DD, Oishi CS et al (1998) 100 cemented versus 100 noncemented stems with comparison of 25 matched pairs. Clin Orthop Relat Res 348:140–148

    Google Scholar 

  6. Tsiridis E, Narvani AA, Haddad FS et al (2004) Impaction femoral allografting and cemented revision for periprosthetic femoral fractures. J Bone Joint Surg Br 86(8):1124–1132

    Article  CAS  PubMed  Google Scholar 

  7. Garbuz DS, Toms A et al (2006) Improved outcome in femoral revision arthroplasty with tapered fluted modular titanium stems. Clin Orthop Relat Res 453:199–202

    Article  PubMed  Google Scholar 

  8. Hultmark P, Karrholm J et al (2000) Cemented first-time revisions of the femoral component: prospective 7 to 13 years’ follow-up using second-generation and third-generation technique. J Arthroplasty 15(5):551–561

    Article  CAS  PubMed  Google Scholar 

  9. Franklin J, Robertsson O et al (2003) Revision and complication rates in 654 Exeter total hip replacements, with a maximum follow-up of 20 years. BMC Musculoskelet Disord 4:6

    Article  PubMed  PubMed Central  Google Scholar 

  10. Bellamy N (2005) The WOMAC knee and hip osteoarthritis indices: development, validation, globalization and influence on the development of the AUSCAN hand osteoarthritis indices. Clin Exp Rheumatol 23(5 Suppl 39):S148–S153

    CAS  PubMed  Google Scholar 

  11. Callaghan JJ, Salvati EA, Pellicci PM et al (1985) Two to five year results of revision total hip replacement. AAOS 52nd Annual Meeting

  12. Pellicci PM, Wilson PD Jr et al (1982) Revision total hip arthroplasty. Clin Orthop Relat Res 170:34–41

    Article  Google Scholar 

  13. Pellicci PM, Wilson PD Jr et al (1985) Long-term results of revision total hip replacement. A follow-up report. J Bone Joint Surg Am 67(4):513–516

    Article  CAS  PubMed  Google Scholar 

  14. Gie GA, Linder L et al (1993) Impacted cancellous allografts and cement for revision total hip arthroplasty. J Bone Joint Surg Br 75(1):14–21

    Article  CAS  PubMed  Google Scholar 

  15. Ling RS, Timperley AJ, Linder L (1993) Histology of cancellous impaction grafting in the femur. A case report. J Bone Joint Surg Br 75(5):693–696

    Article  CAS  PubMed  Google Scholar 

  16. Slooff TJ, Buma P et al (1996) Acetabular and femoral reconstruction with impacted graft and cement. Clin Orthop Relat Res 324:108–115

    Article  Google Scholar 

  17. Kavanagh BF, Fitzgerald RH Jr (1987) Multiple revisions for failed total hip arthroplasty not associated with infection. J Bone Joint Surg Am 69(8):1144–1149

    Article  CAS  PubMed  Google Scholar 

  18. Mulroy WF, Harris WH (1996) Revision total hip arthroplasty with use of so-called second-generation cementing techniques for aseptic loosening of the femoral component. A fifteen-year-average follow-up study. J Bone Joint Surg Am 78(3):325–330

    Article  CAS  PubMed  Google Scholar 

  19. Berry DJ, Harmsen WS et al (1995) Survivorship of uncemented proximally porous-coated femoral components. Clin Orthop Relat Res 319:168–177

    Google Scholar 

  20. Mulliken BD, Rorabeck CH et al (1996) Uncemented revision total hip arthroplasty: a 4-to-6-year review. Clin Orthop Relat Res 325:156–162

    Article  Google Scholar 

  21. Callaghan JJ, Dysart SH et al (1988) The uncemented porous-coated anatomic total hip prosthesis. Two-year results of a prospective consecutive series. J Bone Joint Surg Am 70(3):337–346

    Article  CAS  PubMed  Google Scholar 

  22. Espehaug B, Havelin LI et al (1995) Early revision among 12, 179 hip prostheses. A comparison of 10 different brands reported to the Norwegian Arthroplasty Register, 1987–1993. Acta Orthop Scand 66(6):487–493

    Article  CAS  PubMed  Google Scholar 

  23. Fowler JL, Gie GA et al (1988) Experience with the Exeter total hip replacement since 1970. Orthop Clin North Am 19(3):477–489

    CAS  PubMed  Google Scholar 

  24. Karrholm J, Hultmark P et al (1999) Subsidence of a non-polished stem in revisions of the hip using impaction allograft. Evaluation with radiostereometry and dual-energy X-ray absorptiometry. J Bone Joint Surg Br 81(1):135–142

    Article  CAS  PubMed  Google Scholar 

  25. Alfaro-Adrian J, Gill HS et al (1999) Cement migration after THR. A comparison of Charnley elite and Exeter femoral stems using RSA. J Bone Joint Surg Br 81(1):130–134

    Article  CAS  PubMed  Google Scholar 

  26. Walker PS, Mai SF et al (1995) Prediction of clinical outcome of THR from migration measurements on standard radiographs. A study of cemented Charnley and Stanmore femoral stems. J Bone Joint Surg Br 77(5):705–714

    Article  CAS  PubMed  Google Scholar 

  27. Krismer M, Biedermann R et al (1999) The prediction of failure of the stem in THR by measurement of early migration using EBRA-FCA. Einzel-Bild-Roentgen-Analyse-femoral component analysis. J Bone Joint Surg Br 81(2):273–280

    Article  CAS  PubMed  Google Scholar 

  28. Nelissen RG, Garling EH et al (2005) Influence of cement viscosity and cement mantle thickness on migration of the Exeter total hip prosthesis. J Arthroplasty 20(4):521–528

    Article  PubMed  Google Scholar 

  29. Ek ET, Choong PF (2005) Comparison between triple-tapered and double-tapered cemented femoral stems in total hip arthroplasty: a prospective study comparing the C-Stem versus the Exeter universal early results after 5 years of clinical experience. J Arthroplasty 20(1):94–100

    Article  PubMed  Google Scholar 

  30. Knight JL, Helming C (2000) Collarless polished tapered impaction grafting of the femur during revision total hip arthroplasty: pitfalls of the surgical technique and follow-up in 31 cases. J Arthroplasty 15(2):159–165

    Article  CAS  PubMed  Google Scholar 

  31. Eldridge JD, Smith EJ et al (1997) Massive early subsidence following femoral impaction grafting. J Arthroplasty 12(5):535–540

    Article  CAS  PubMed  Google Scholar 

  32. Meding JB, Et MA et al (1997) Impaction bone-grafting before insertion of a femoral stem with cement in revision total hip arthroplasty. A minimum two-year follow-up study. J Bone Joint Surg Am 79(12):1834–1841

    Article  CAS  PubMed  Google Scholar 

  33. Masterson EL, Masri BA et al (1997) The cement mantle in the Exeter impaction allografting technique. A cause for concern. J Arthroplasty 12(7):759–764

    Article  CAS  PubMed  Google Scholar 

  34. Elting JJ, Mikhail WE et al (1995) Preliminary report of impaction grafting for exchange femoral arthroplasty. Clin Orthop Relat Res 319:159–167

    Google Scholar 

  35. Selvik G (1989) Roentgen stereophotogrammetry. A method for the study of the kinematics of the skeletal system. Acta Orthop Scand Suppl 232:1–51

    Article  CAS  PubMed  Google Scholar 

  36. Schreurs BW, Arts JJ et al (2005) Femoral component revision with use of impaction bone-grafting and a cemented polished stem. J Bone Joint Surg Am 87(11):2499–2507

    PubMed  Google Scholar 

Download references

Conflict of interest statement

We certify that there is no actual or potential conflict of interest in relation to this article.

Author information

Authors and Affiliations

  1. The Heart of England NHS Trust, Lode Lane Solihull, Birmingham, UK

    K. Randhawa, F. S. Hossain, B. Smith, Cyril Mauffrey & T. Lawrence

  2. Birmingham Heartlands and Solihull Hospital, Lode Lane, 456 Warwick Road, Solihull, West Midlands, B911AG, UK

    Cyril Mauffrey

Authors
  1. K. Randhawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. S. Hossain
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cyril Mauffrey
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. T. Lawrence
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cyril Mauffrey.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Randhawa, K., Hossain, F.S., Smith, B. et al. A prospective study of hip revision surgery using the Exeter long-stem prosthesis: function, subsidence, and complications for 57 patients. J Orthopaed Traumatol 10, 159–165 (2009). https://doi.org/10.1007/s10195-009-0068-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10195-009-0068-0

Keywords

Search

Navigation