The Exeter Universal Hip Replacement for patients who were 50 years or younger at time of surgery. A minimum 10 year follow up.

• B .Squires, A Ellis, J Timperley, G Gie, R Ling,  N Wendover. - Princess Elizabeth Orthopaedic Hospital, Exeter.

The aim of this study was to determine the medium term survivorship and function of the cemented Exeter Universal Hip Replacement when used in younger patients; a group that is deemed to place high demands on their arthroplasties.

Since 1988 The Exeter Hip Research Unit has prospectively gathered data on all patients who have had total hip replacements at the Princess Elizabeth Orthopaedic Hospital. This cohort of patients included those living in districts remote from Exeter. There were 88 Exeter Universal total hip replacements (THR) in 71 patients who were 50 years or younger at the time of surgery and whose surgery was performed at least 10 years before. Mean age at surgery was 43 y (range 24y to 50y.) 5 patients who had 7 THRs had died leaving 81 THRs for review. Patients were reviewed in clinic at an average of 11.4 years (10 – 13 years). No patient was lost to follow up.

Results:
At review, 8 hips had been revised. 5 cases were for loose cemented metal backed acetabular prosthesis. Two femoral components were revised for infection and one for aseptic loosening. Radiographs showed that a further 10 (13%) acetabular prosthesis were loose and that 3 femurs showed significant osteolysis.

Overall 10 year survivorship of stem and cup from all causes was 93%. The 10 year survivorship of stem only from all causes was 98% and from aseptic loosening was  99%.

Conclusion: The Exeter Universal Stem performs extremely well in the younger patient. However the high failure rate of the cemented metal backed Exeter acetabular component has compromised the overall results in this series.

Addendum
This group of young patients has recently been reviewed and the Survivorship re-calculated at 15 years:

• Survivorship with end point revision for aseptic socket loosening  87% at 15 years

• Survivorship with end point revision for aseptic stem loosening 97.6% at 15 years

• Survivorship with end-point revision for any reason: 84% at 15 years