Robin Sydney Mackwood Ling

The long-term results of the original Exeter polished cemented femoral component: a follow-up report.

We present a long-term follow-up report of the results of the original Exeter polished cemented stems inserted between November 1970 and the end of 1975 at our institution by surgeons of widely differing experience using crude cementing techniques. The results of this series were reported in 1988 (Fowler et al. Orthopaedic Clinics of North America. 1988;19:477) and again in 1993 (Timperley et al. Journal of Bone and Joint Surgery. 1993;75-B:33). There have been no failures from aseptic femoral component loosening since the 1993 report. From the original series of 433 hips, there were, at the end of 2003, 26 living patients with 33 hips. Of the latter, there were 25 hips in 20 patients with their original femoral components still in situ. Twenty-eight (6.46%) hips from the original series have been lost to follow-up, although none since 1992. With the end point reoperation for aseptic stem loosening, the survivorship is 93.5% (95% confidence interval, 90.0%-97.0%). The reoperation rate for aseptic femoral component loosening is 3.23% into the 33rd year of follow-up.

Original ArticleThe Long-Term Results of the Original Exeter Polished Cemented Femoral Component: A Follow-up Report

We present a long-term follow-up report of the results of the original Exeter polished cemented stems inserted between November 1970 and the end of 1975 at our institution by surgeons of widely differing experience using crude cementing techniques. The results of this series were reported in 1988 (Fowler et al. Orthopaedic Clinics of North America. 1988;19:477) and again in 1993 (Timperley et al. Journal of Bone and Joint Surgery. 1993;75-B:33). There have been no failures from aseptic femoral component loosening since the 1993 report. From the original series of 433 hips, there were, at the end of 2003, 26 living patients with 33 hips. Of the latter, there were 25 hips in 20 patients with their original femoral components still in situ. Twenty-eight (6.46%) hips from the original series have been lost to follow-up, although none since 1992. With the end point reoperation for aseptic stem loosening, the survivorship is 93.5% (95% confidence interval, 90.0%-97.0%). The reoperation rate for aseptic femoral component loosening is 3.23% into the 33rd year of follow-up.

Long-Term Success with a Double Tapered Polished Straight Stem

The first double tapered, polished, collarless, straight femoral stem for cemented total hip arthroplasty (THA) to be used in clinical practice was the Exeter stem, designed in 1969 by Robin Ling and Clive Lee, in Exeter, UK. It has been in use in clinical practice since 1970 and excellent long-term results up to 33 years are now available. The Exeter is currently the most commonly used cemented stem, not only in the UK, but worldwide.

Is It Justified to Cement All Sockets

Cemented sockets have provided good long-term outcome with lower overall re-operation rates than cementless designs. Results of cementless sockets implanted with polyethylene liners have been disappointing with increased wear rates and a higher incidence of pelvic and femoral osteolysis. Re-operation rates for problems on the socket side have been higher in almost all reports of cementless socket results. There are no long-term results of using highly cross-linked polyethylene liners; likewise, the fate of hard on hard bearings with contemporary socket design is not known. Results using cemented sockets are further improved when contemporary surgical techniques are used, with published evidence of a low risk for revision at more than fifteen years. With cemented sockets, the likelihood of long term success can be estimated on the first postoperative radiograph and there is strong evidence that the longevity of any socket with regard to mechanical loosening is determined by the surgeon and his/her team on the day of surgery.

Stem Design - The Surgeon’s Perspective

This chapter considers the principles behind the design of cemented femoral stems and concentrates on the issues that are important to the surgeon when selecting a stem for use in clinical practice. Two main issues are central to a surgeon’s choice of implant in hip replacement surgery: long-term function of the prosthesis and the versatility of the hip replacement system. The first part of the chapter examines how stem design may affect fixation of the stem within the femur and the long-term performance of a hip replacement. The second part of the chapter considers the needs of the surgeon in the operating room and how design of a cemented stem system may help the surgeon recreate each patient’s anatomy and thereby achieve the optimum outcome.