THE EXETER TECHNIQUE: RESULTS AFTER REVISION TOTAL HIP ARTHROPLASTY FOR FEMORAL LOOSENING IN 18 HIPS

Abstract

Purpose: The purpose of this work was to present clinical and radiographic results of our experience with the Exeter technique for femoral reconstruction during revision total hip arthroplasty.

Material and methods: Eighteen patients (18 hips) underwent surgery between 1994 and 2001 and were reviewed a mean 3.5 years (1–7.5). Mean age was 67.2 years (27–78). These patients had aseptic loosening (17 hips) or septic loosening (1 hip). The femoral loosening was stage II in six hips and stage III in twelve according to the SOFCOT classification. The mean preoperative Postel Merle d’Aubigné (PMA) score was 13.6 [pain 3.4 (2–5), motion (5.9, function 3.8 (2–6)]. Postoperative assessment noted complications, the PMA score and radiographically, search for lucent lines, graft aspect, and cortical classification (Gie). Prosthesis migration was measured with the EBRAFCA method. The alpha risk was set at 5% for statistical analysis.

Results: Five complications were noted: three greater trochanter fractures, one sernsorimotor ischiatic deficit, one infraprosthetic fracture at 4.5 months. The overall mean PMA score at last follow-up was 17 [pain 5.4 (3–6), motion 6, function 5.6 (4–6)]. Radiographically thirteen hips exhibited cortical thickening with incorporation of the graft, with one case of isolated cortical thickening. One case could not be analysed (metal mesh). The EBRA analysis was used in 14 hips. After the stage II lesions, median descent was 2.8 mm (1.55–6.25) versus respectively 6.5 mm (2.1–8.7) in stage III (p=0.35)].

Discussion: The Exeter technique is one solution for femoral bone stock loss during revision THA. This technique has provided good clinical outcome (overall final PMA 17 versus 13). Radiographically, in the majority of the cases, graft integration was satisfactory with no sign of loosening. Prosthetic descent (EBRA analysis) was slightly greater than published results but there was no correlation with the initial lesion or the clinical outcome.

Conclusion: The Exeter technique is reliable and effective. It provides a less aggressive solution compared with other techniques for femoral bone loss.