The Influence of Migration of the Exeter V40 Stem on Patient Reported Outcome Measures: a 2-year Follow-up of 112 Total Hip Arthroplasties Using Radiostereometric Analysis

Overview

Journal Eur J Orthop Surg Traumatol

Specialty Orthopedics

Date 2021 Mar 25

PMID 33763771

Citations 1

Authors

Daniel K Steiner

Nikolaj S Drivsholm

Sebastian T E Buchardt

Mogens Laursen

Affiliations

Soon will be listed here.

Abstract

Purpose: The cemented Exeter V40 stem is known to migrate distally. Several previous studies have reported on the extent of stem migration and its influence on clinical outcome. However, no studies have investigated the influence of stem migration on Patient Reported Outcome Measures (PROM).

Methods: One hundred and twelve total hip arthroplasties (THA) were included in a 2-year follow-up using Radiostereometric Analysis (RSA). Patients were evaluated using the Oxford Hip Score (OHS) and EQ-5D-3L PROMs. The purpose of this study was to assess the influence of stem migration, measured by Maximum Total Point Motion (MTPM), on the 2-year postoperative score (OHS and EQ-5D). Furthermore, the influence of pre-operative PROM, age, gender, acetabular component and BMI was associated with the 2-year postoperative OHS and EQ-5D scores.

Results: MTPM was a non-significant predictor of the 2-year postoperative OHS (regression coefficient (B) = - 2.38 (CI - 5.44; .69)) and of the 2-year postoperative EQ-5D (B = - .01 (CI - .04; .02)). The only significant predictor of the 2-year postoperative OHS and 2-year postoperative EQ-5D was gender (B = 8.71 (CI 3.52; 13.90)) and (B = .13 (CI .07; .18)), respectively.

Conclusion: Stem migration did not significantly influence PROMs at 2 years post-operatively. Using a patient-focused approach, our results seem to corroborate results reported by previous studies, showing that slow migration of the Exeter V40 stem does not seem to influence the clinical outcome.

Citing Articles

Tibial Baseplate Migration Is Not Associated with Change in Patient-Reported Outcome Measures and Clinical Scores After TKA: A Secondary Analysis of 5 Radiostereometric Analysis Studies with 10-Year Follow-up.

van der Lelij T, Kaptein B, Tsonaka R, Nelissen R, Toksvig-Larsen S, Marang-van de Mheen P J Bone Joint Surg Am. 2024; 106(16):1479-1485.

PMID: 38941476 PMC: 11594081. DOI: 10.2106/JBJS.23.00957.

References

Shen G . Femoral stem fixation. An engineering interpretation of the long-term outcome of Charnley and Exeter stems. J Bone Joint Surg Br. 1998; 80(5):754-6. DOI: 10.1302/0301-620x.80b5.8621. View

Stefansdottir A, Franzen H, Johnsson R, Ornstein E, Sundberg M . Movement pattern of the Exeter femoral stem; a radiostereometric analysis of 22 primary hip arthroplasties followed for 5 years. Acta Orthop Scand. 2004; 75(4):408-14. DOI: 10.1080/00016470410001169-1. View

Alfaro-Adrian J, Gill H, Murray D . Should total hip arthroplasty femoral components be designed to subside? A radiostereometric analysis study of the Charnley Elite and Exeter stems. J Arthroplasty. 2001; 16(5):598-606. DOI: 10.1054/arth.2001.23576. View

Nieuwenhuijse M, Valstar E, Kaptein B, Nelissen R . The Exeter femoral stem continues to migrate during its first decade after implantation: 10-12 years of follow-up with radiostereometric analysis (RSA). Acta Orthop. 2012; 83(2):129-34. PMC: 3339525. DOI: 10.3109/17453674.2012.672093. View

Greene M, Rolfson O, Gordon M, Annerbrink K, Malchau H, Garellick G . Is the use of antidepressants associated with patient-reported outcomes following total hip replacement surgery?. Acta Orthop. 2016; 87(5):444-51. PMC: 5016901. DOI: 10.1080/17453674.2016.1216181. View

Paulsen A, Odgaard A, Overgaard S . Translation, cross-cultural adaptation and validation of the Danish version of the Oxford hip score: Assessed against generic and disease-specific questionnaires. Bone Joint Res. 2013; 1(9):225-33. PMC: 3626210. DOI: 10.1302/2046-3758.19.2000076. View

Aalund P, Glassou E, Hansen T . The impact of age and preoperative health-related quality of life on patient-reported improvements after total hip arthroplasty. Clin Interv Aging. 2017; 12:1951-1956. PMC: 5694207. DOI: 10.2147/CIA.S149493. View

Singh J, Lewallen D . Age, gender, obesity, and depression are associated with patient-related pain and function outcome after revision total hip arthroplasty. Clin Rheumatol. 2009; 28(12):1419-30. PMC: 2963019. DOI: 10.1007/s10067-009-1267-z. View

Biring G, Masri B, Greidanus N, Duncan C, Garbuz D . Predictors of quality of life outcomes after revision total hip replacement. J Bone Joint Surg Br. 2007; 89(11):1446-51. DOI: 10.1302/0301-620X.89B11.19617. View

10.

Jameson S, Mason J, Baker P, Elson D, Deehan D, Reed M . The impact of body mass index on patient reported outcome measures (PROMs) and complications following primary hip arthroplasty. J Arthroplasty. 2014; 29(10):1889-98. DOI: 10.1016/j.arth.2014.05.019. View

11.

Karrholm J . Roentgen stereophotogrammetry. Review of orthopedic applications. Acta Orthop Scand. 1989; 60(4):491-503. DOI: 10.3109/17453678909149328. View

12.

Valstar E, Gill R, Ryd L, Flivik G, Borlin N, Karrholm J . Guidelines for standardization of radiostereometry (RSA) of implants. Acta Orthop. 2005; 76(4):563-72. DOI: 10.1080/17453670510041574. View

13.

Ejaz A, Laursen A, Jakobsen T, Rasmussen S, Nielsen P, Laursen M . Absence of a Tourniquet Does Not Affect Fixation of Cemented TKA: A Randomized RSA Study of 70 Patients. J Arthroplasty. 2015; 30(12):2128-32. DOI: 10.1016/j.arth.2015.05.058. View

14.

Paulsen A, Roos E, Pedersen A, Overgaard S . Minimal clinically important improvement (MCII) and patient-acceptable symptom state (PASS) in total hip arthroplasty (THA) patients 1 year postoperatively. Acta Orthop. 2013; 85(1):39-48. PMC: 3940990. DOI: 10.3109/17453674.2013.867782. View

15.

Beard D, Harris K, Dawson J, Doll H, Murray D, Carr A . Meaningful changes for the Oxford hip and knee scores after joint replacement surgery. J Clin Epidemiol. 2014; 68(1):73-9. PMC: 4270450. DOI: 10.1016/j.jclinepi.2014.08.009. View