Abstract
Introduction: Between 1988 and 1993 we performed 154 primary hip arthroplasties with the Exeter Universal femoral stem and a variety of acetabular components and describe our experience after a minimum follow up of 10.5 years (mean 12.6 years).
65 hips were assessed clinically and radiologically.
Our aim was to establish whether results from the inventing centre for the Exeter Universal stem were reproducible and to identify the features of cementing technique associated with survival of this prosthesis.
Results: At follow up the mean Oxford hip score was 24. Our stem revision rate was 1.7% and cup revision 13%. The majority of the cup failures occurred between 8 and 15 years and were the non flanged cemented metal backed Exeters which tended to both wear and migrate. We intend to revise 11 hips in 10 patients. 10 of these are for migration and or wear of the metal backed Exeter cup and one for distal stem-cement dissociation of the stem in a patient with thigh pain. Radiologically this stem showed migration and lucent lines at the cement-stem interface. 6% of stems had cement mantle defects, which were associated with endosteal lysis. Stem subsidence was related to Barrack’s grading for cementing technique. The worse the Barrack grade the more the prosthesis subsided within the cement mantle.
Conclusion: A complete cement mantle rather than 3rd generation cement compression is important for long term fixation of the femoral component. The Exeter universal stem is relatively forgiving of surgical technique. The cemented, collarless polished tapered device is suitable for general use and represents the reference standard for cemented femoral components.
Editoral Secretary Mr Peter Howard. Correspondence should be addressed to BHS at the Royal College of Surgeons, 35 - 43 Lincoln’s Inn Fields, London WC2A 3PN.
