A systematic review of short- compared with standard-length Exeter stems in primary total hip arthroplasty.

IF 4.9 1区医学 Q1 ORTHOPEDICS

Bone & Joint Journal Pub Date : 2025-01-01 DOI:10.1302/0301-620X.107B1.BJJ-2024-0305.R1

Stephen Mc Donald, Andrel Yoong, Jonathan T Evans, Luke Farrow

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引用次数: 0

Abstract

Aims: The Exeter femoral stem has a cemented, polished taper-slip design, and an excellent track record. The current range includes short-length options for various offsets, but less is known about the performance of these stems. The aim of this study was to compare the survival of short-length stems with standard-length Exeter stems.

Methods: A systematic review of all studies reporting the use of short-length Exeter stems in primary total hip arthroplasty (THA) was undertaken. Survival data, the indication for revision, and patient-reported outcomes were gathered from observational and randomized studies. Studies based on registry data were analyzed separately.

Results: The review included nine studies which covered a total of 2,190 short stems. The mean follow-up was 6.4 years (2 to 12) with an all-cause survival of 95.4%. When revisions due to aseptic acetabular loosening were excluded, the survival was 97.7%. Four stems fractured (0.18%). The mean Oxford Hip Score improved from 18.29 (1.33 to 21.6) preoperatively to 41.59 (32.9 to 43.4) at final follow-up. Three studies used data from national registries. A total of 25,895 short stems (offset ≤ 35.5 mm) were used compared with 336,218 standard-length stems. In these studies, short stems had a hazard ratio (HR) for all-cause survival of 1.19 (95% CI 0.96 to 1.43) with a rate of revision per 1,000 component-years of 0.037 compared with 0.035 for standard-length stems. One study from the New Zealand Joint Registry divided short stems into standard and small offset groups. Standard offset short stems (≥ 37.5 mm) had a 0.84 HR (95% CI 0.38 to 1.88) while small offset short stems (≤ 35.5 mm) had a 1.6 HR compared with standard stems (95% CI 1.3 to 1.98).

Conclusion: Short Exeter stems perform well and are a safe femoral component in primary THA, according to the current literature. There does not appear to be an increased risk of implant fracture associated with these stems.

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在初次全髋关节置换术中比较短与标准长度埃克塞特假体的系统综述。

目的：Exeter股骨干具有胶结、抛光的锥形滑动设计，具有良好的跟踪记录。目前的范围包括各种偏移的短长度选项，但对这些茎的性能知之甚少。本研究的目的是比较短茎和标准长度埃克塞特茎的存活率。方法：系统回顾了所有报道在初次全髋关节置换术（THA）中使用短长度埃克塞特假体的研究。生存数据、修订适应症和患者报告的结果来自观察性和随机研究。基于注册表数据的研究分别进行分析。结果：该综述包括9项研究，共涉及2190个短茎。平均随访6.4年（2 ~ 12年），全因生存率为95.4%。当排除无菌性髋臼松动引起的翻修时，生存率为97.7%。4根茎断裂（0.18%）。平均牛津髋关节评分从术前的18.29（1.33 - 21.6）提高到最终随访时的41.59（32.9 - 43.4）。三项研究使用了国家登记处的数据。与336,218根标准长度茎相比，总共使用了25,895根短茎（偏移量≤35.5 mm）。在这些研究中，短茎的全因生存风险比（HR）为1.19 (95% CI 0.96至1.43)，每1000个成分年的修正率为0.037，而标准长度茎的修正率为0.035。新西兰联合登记处的一项研究将短茎分为标准组和小组。标准偏置短茎（≥37.5 mm）的HR为0.84 (95% CI 0.38 ~ 1.88)，而小偏置短茎（≤35.5 mm）的HR为1.6 （95% CI 1.3 ~ 1.98）。结论：根据目前的文献，短埃克塞特柄在原发性全髋关节置换术中表现良好，是一种安全的股骨假体。与这些柄相关的植入物骨折的风险似乎没有增加。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Bone & Joint Journal ORTHOPEDICS-SURGERY

CiteScore

9.40

自引率

10.90%

发文量

318

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