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. 2023 Jul 6;4(7):507-515.
doi: 10.1302/2633-1462.47.BJO-2023-0008.R1.

Less early subsidence of cemented Exeter short stems compared with cemented Exeter standard stems in Dorr type A femurs

Affiliations

Less early subsidence of cemented Exeter short stems compared with cemented Exeter standard stems in Dorr type A femurs

Peter B Jørgensen et al. Bone Jt Open. .

Abstract

Aims: The Exeter short stem was designed for patients with Dorr type A femora and short-term results are promising. The aim of this study was to evaluate the minimum five-year stem migration pattern of Exeter short stems in comparison with Exeter standard stems.

Methods: In this case-control study, 25 patients (22 female) at mean age of 78 years (70 to 89) received cemented Exeter short stem (case group). Cases were selected based on Dorr type A femora and matched first by Dorr type A and then age to a control cohort of 21 patients (11 female) at mean age of 74 years (70 to 89) who received with cemented Exeter standard stems (control group). Preoperatively, all patients had primary hip osteoarthritis and no osteoporosis as confirmed by dual X-ray absorptiometry scanning. Patients were followed with radiostereometry for evaluation of stem migration (primary endpoint), evaluation of cement quality, and Oxford Hip Score. Measurements were taken preoperatively, and at three, 12, and 24 months and a minimum five-year follow-up.

Results: At three months, subsidence of the short stem -0.87 mm (95% confidence interval (CI) -1.07 to -0.67) was lower compared to the standard stem -1.59 mm (95% CI -1.82 to -1.36; p < 0.001). Both stems continued a similar pattern of subsidence until five-year follow-up. At five-year follow-up, the short stem had subsided mean -1.67 mm (95% CI -1.98 to -1.36) compared to mean -2.67 mm (95% CI -3.03 to -2.32) for the standard stem (p < 0.001). Subsidence was not influenced by preoperative bone quality (osteopenia vs normal) or cement mantle thickness.

Conclusion: The standard Exeter stem had more early subsidence compared with the short Exeter stem in patients with Dorr type A femora, but thereafter a similar migration pattern of subsidence until minimum five years follow-up. Both the standard and the short Exeter stems subside. The standard stem subsides more compared to the short stem in Dorr type A femurs. Subsidence of the Exeter stems was not affected by cement mantle thickness.

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Conflict of interest statement

The authors declare no conflicts of interest. M. Stilling is President of the International Radiostereometry Society.

Figures

Fig. 1
Fig. 1
Flowchart. RSA, radiostereometric analysis.
Fig. 2
Fig. 2
3D models of the Exeter short stem (blue) and Exeter standard stem (grey) showns that a) and b) the short stem has a similar taper but distributed on a shorter stem (a, b), and proximal geometry similar to the standard stem (c, d).
Fig. 3
Fig. 3
Anterior/posterior and cross-table lateral radiographs of a right hip with Exeter short stem. Modified Grüen zones were used in the radiographic evaluation. The periprosthetic bone was evenly divided from tip to shoulder. Proximal zones ended with the cement mantle. The zones were numbered from lateral to medial and from anterior to posterior.
Fig. 4
Fig. 4
Graphic results from mixed model analysis showing a) and b) stem subsidence (-), c) valgus(+)/varus(-) stem rotation, and d) stem retroversion(+)/anteversion(-).

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