Abstract
Purpose: The Exeter technique opens new perspectives for the treatment of femoral bone loss observed at revision hip arthroplasty. Early migration of the implant, considered by the advocates of the technique to be beneficial when limited, can, in the absence of secondary instability, weaken the cement shield leading to early revision. Several publications on this topic have examined the improvement in primary stability achieved by modifying the impaction technique or by searching for the ideal size of the grafts. The purpose of the present study was to examine the reproducibility of this method and its effect on transformation of the allograft.
Material and methods: We performed a prospective analysis of outcome in 46 patients operated on since 1996. The Poste-Merle-d’Aubigné (PMA) clinical score and the Ling and Gie radiographic score as well as the SOFCOT score for substance loss were determined. We used frozen fragmented allografts without consideration of graft size. A standard sized femoral implant was used in all cases.
Results: Mean follow-up was 3 years (range 12 – 66 months). Four patients were not followed beyond 9 months because of major complications requiring revision surgery (infection, fracture of the femur, malposition) or patient death (stroke). For the remaining 42 patients, loss of femoral stock was scored I in 6, II in 23, III in 13. The functional score improved from 9.13±3.9 preoperatively to 16.07±2.5 postoperatively. Radiographically, bone lines were observed in the graft in 36 patients, associated with bone remodelling in ten. In six patients, the allograft exhibited a heterogeneous aspect. Three implants migrated 4 mm. Defective distal sealing was noted in all three. One prosthesis implanted in a varus position worsened before stabilising.
Discussion: This technique is a reliable method since primary stability of the implant was obtained in 90% of the cases and was maintained during long follow-up. This did not prevent graft remodelling.
The abstracts were prepared by Docteur Jean Barthas. Correspondence should be addressed to him at Secrétariat de la Société S.O.F.C.O.T., 56 rue Boissonade, 75014 Paris.
