Abstract
Introduction
The removal of a well fixed cement mantle for revision of a total hip replacement (THR) can be technically challenging and carries significant risks. Therefore, a cement-in-cement revision of the femoral component is an attractive option.
The Exeter Short Revision Stem (SRS) is a 125 mm polished taper stem with 44 mm offset specifically designed for cement-in-cement revisions. Only small series using this implant have been reported.
Patients/Materials & Methods
Records for all patients who had undergone a cement-in-cement revision with the SRS were assessed for 1) radiological femoral component loosening 2) clinical femoral component loosening 3) further revision of the femoral component 4) complications.
We assessed serial radiographs for changes within the cement mantle and for implant subsidence.
Results
50 implants in 46 patients were reviewed. Mean age at surgery was 67.7 (range 39–88) years.
7 patient (8 implant) deaths at mean 128 (range 17 – 267) weeks following surgery were identified.
Complications included one intra-operative greater trochanter fracture, one femoral nerve palsy, and one early infection following surgery.
Three implants required revision. One at 11 weeks following surgery for recurrent dislocation, one at 138 weeks for infection and one at 290 weeks for breakage of the femoral implant.
The mean time from surgery to both radiographic and clinical follow-up was 3.4 years.
Radiographs available for 48 implants showed no radiographic evidence of loosening.
Clinical follow-up information was available for 45 patients. Only one patient reported thigh pain but a bone scan showed no evidence of loosening.
Discussion
This is the largest reported series with SRS we are aware of outside the design centre.
Conclusions
The Exeter Short Revision Stem provides a viable option for cement-in-cement revision surgery. Further evaluation of the use of this implant in patients with a high BMI is required given the implant failure in this series and the reported literature.
