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Migration pattern of cemented Exeter short stem in Dorr type A femurs. A prospective radiostereometry study with 2-year follow-up

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The Exeter short stem (ESS) is 25 mm shorter than the standard length v40 Exeter stem (Stryker) and intended for a narrow femoral diaphysis. The purpose of the study was to evaluate the migration pattern of the cemented ESS.

Material and method

In a prospective single-center cohort study, 23 patients (21 female) mean age 78 (range 70–89) with hip osteoarthritis and Dorr Type A femurs were included. Preoperative DXA was used to group patients into normal (> − 1) and low (< − 1) T-score. Components were the collarless polished double-tapered Exeter short stem type N°1 L125. Patients were followed for 2 years with model-based RSA (stem migration), regular hip radiographs (stem position and cementation quality), Oxford Hip Score (OHS) and VAS pain.

Results

At 2-year follow-up, the stems subsided 1.48 mm (CI 95% 1.69; 1.26) and retroverted 0.45° (CI 95% 0.01; 0.88). From 12 to 24 months, stem subsidence was 0.18 mm (CI 95% 0.1; 0.25) (p = 0.001) and retroversion was − 0.04° (CI 95% − 0.27; 0.18) (p = 0.70). T-score and stem subsidence correlated (rho = 0.48; p = 0.025) and patients with normal T-score (n = 7) had 0.42 mm (CI 95% − 0.01; 0.85) less subsidence as compared to patients with low T-score (n = 15) (p = 0.054). Stems in varus position (n = 9) subsided 1.7 mm (CI 95% 1.35; 2.05) compared to 1.33 mm (CI 95% 1.05; 1.60) for stems in neutral position (n = 13) (p = 0.07). Postoperative cementation quality did not influence 2-year stem migration. OHS improved to 40.7 (CI 95% 36.8; 44.7) and VAS pain at rest and activity decreased to 5 mm and 10 mm, respectively (p < 0.001).

Conclusion

The 2-year migration pattern of the cemented ESS was similar to reports for the cemented standard length Exeter stem. Low preoperative T-score and varus stem-position showed a tendency for higher stem migration and should be studied as risk factors for failure in larger studies of cemented polished stems.

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Funding

Stryker Inc supported the study financially but had no influence on the data interpretation, manuscript or publication.

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Authors and Affiliations

  1. Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus, Denmark

    Tobias Dahl Vind, Peter Bo Jørgensen, Stig Storgaard Jakobsen, Kjeld Søballe & Maiken Stilling

  2. Aarhus University, Aarhus, Denmark

    Tobias Dahl Vind

  3. Hospital Unit West, University Clinic for Hand, Hip and Knee Surgery, Lægårdvej 12, 7500, Holstebro, Denmark

    Dovydas Vainorius

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  1. Tobias Dahl Vind
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Contributions

DV, KS and MS designed the study. SSJ operated the patients and collected the data. TDV and PBJ performed the image analyses and statistical analyses. TDV, PBJ and MS wrote the manuscript. All authors contributed to data interpretation and manuscript revision.

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Correspondence to Tobias Dahl Vind.

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The authors report no conflicts of interest/competing interests.

Ethics approval

The study was approved by the Data Protection Agency (1-16-02-545-13) and the Central Denmark Regions Committee on Biomedical Research Ethics (1-10-72-346-13) and was performed in agreement with the Helsinki II declaration.

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All patients consented in writing after receiving oral and written project information.

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Vind, T.D., Jørgensen, P.B., Vainorius, D. et al. Migration pattern of cemented Exeter short stem in Dorr type A femurs. A prospective radiostereometry study with 2-year follow-up. Arch Orthop Trauma Surg 143, 1071–1080 (2023). https://doi.org/10.1007/s00402-021-04307-y

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