Exeter Universal cemented stem for THA yielded ‘excellent’ long-term survivorship
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Use of the Exeter Universal cemented stem during total hip arthroplasty in young patients had “excellent survivorship” at 20 years, according to published results.
Researchers reviewed clinical and radiological outcomes of 107 patients (130 hips) aged 50 years or younger at primary THA who received the Exeter Universal cemented stem (Stryker Orthopedics). Researchers followed all patients at 5-year intervals and no patients were lost to follow-up.
At a mean follow-up of 22 years, researchers found 79 surviving hips and 11 patients were deceased. Results showed revision in 37 hips due to aseptic cup loosening (n=29), femoral osteolysis (n=3), acetabular polyethylene wear (n=2), infection (n=2), Gaucher’s disease (n=1), broken stem (n=1) and cup instability (n=1). Researchers noted no patients experienced aseptic loosening of the Exeter stem. Although eight patients had radiological evidence of loosening of the cemented cup, results showed no radiologically loose stems. At 22 years, patients had a survivorship of 74.9% for all-cause revision and of 96.3% for revision of the stem for either aseptic loosening or lysis, according to results.
“The Exeter stem has been shown to have excellent survival rates in both older and younger patients in many published studies,” the authors wrote. “Knowledge of survivorship beyond the 2-year mark is paramount when treating patients for THA in their 40s and younger. This study shows that the Exeter stem can be used successfully to treat this active, demanding patient group in the long term.” – by Casey Tingle
Disclosures: Keeling reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Eric Cohen, MD
Based on several registry studies, cementless femoral fixation has excellent long-term survivorship in young active arthroplasty patients and is the preferred mode of fixation in the United States. Many surgeons have not utilized cemented femoral stems for young patients due to concerns over longevity.
The authors report excellent 20-year survivorship of the Exeter cemented femoral stem in young patients. The Exeter stem originated at the reporting institution, however their results included both expert arthroplasty surgeons and non-arthroplasty surgeons which may make the results more applicable to other institutions. There were no aseptic femoral revisions with the vast majority of revisions due to osteolysis and acetabular complications.
There are unique advantages to the Exeter cemented femoral stem including the ability to be utilized in a variety of different femoral bone morphology and the ability during a revision to perform a cement in cement technique as long as cement mantle is intact. This study of cemented Exeter femoral stem provides an additional option for surgeons to consider in the young active arthroplasty patient.
Warren Alpert Medical School of Brown University
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