Long-term survival of the cemented Exeter Universal Stem in patients 50-years and under: An update on 130 hips

Abstract Background There is variable evidence regarding survivorship beyond 20-years of THAs in young patients. We report the long-term results of the Exeter cemented hip system in patients ≤50 at minimum of 20-years. Methods Clinical and radiological outcomes of 130 consecutive THAs in 107 patients aged 50-years or younger at primary operation were reviewed; 77% had a diagnosis other than osteoarthritis. All patients were followed at five-year intervals, no patients were lost to follow-up and the status of every implant is known. Results Mean age at surgery was 41.8 (17-50) years. Mean follow-up was 22.0 (20.0-26.1) years. There were 79 hips surviving, 14 hips (11 patients) deceased, 37 hips revised. Reasons for revision: 29 hips for aseptic cup loosening (26 stems revised using cement-in-cement, three left in-situ); three stems for femoral osteolysis, two related to acetabular polyethylene wear (14.1 & 17.0yrs), one with Gaucher’s disease (21.1yrs); one broken stem (12.9yrs); one cup for instability (4.3yrs – stem revised using cement-in-cement); and two hips with infection (8.5 & 23.8yrs). There were no cases of aseptic loosening of the Exeter stem. There were no radiologically loose stems although eight patients had radiological evidence of loosening of the cemented cup. Survivorship at 22-years was 74.9% for revision for all causes and 96.3% for revision of the stem for aseptic loosening or lysis. Conclusion The Exeter cemented stem has excellent survivorship at minimum 20-years in young patients. Acetabular component survivorship was less favourable but the advent of highly cross-linked polyethylene may improve this in the long-term.