WHAT MUST BE A WELL-CEMENTED PROSTHESIS? Graham Gie FRCSEd(Orth) PEOC Exeter

WHAT MUST BE A WELL- CEMENTED PROSTHESIS? Surgical Technique Type of Implant

A good cemented THA:

Conducted by a skilled surgeon A good cemented THA: Conducted by a skilled surgeon

Conducted by a skilled surgeon A good cemented THA: Conducted by a skilled surgeon Through an adequate exposure with consideration for bony & soft tissue structures

Conducted by a skilled surgeon Minimising complications A good cemented THA: Conducted by a skilled surgeon Through an adequate exposure with consideration for bony & soft tissue structures Minimising complications

A good cemented THA: Conducted by a skilled surgeon Through an adequate exposure with consideration for bony & soft tissue structures Minimising complications Using modern cementing techniques & instrumentation

A good cemented THA: Conducted by a skilled surgeon Through an adequate exposure with consideration for bony & soft tissue structures Minimising complications Using modern cementing techniques & instrumentation And a tried and tested prosthesis

Conducted by a skilled surgeon Who performs the procedure frequently A good cemented THA: Conducted by a skilled surgeon Who performs the procedure frequently

Performs the procedure frequently PRACTICE MAKES PERFECT Skilled Surgeon? Gifted? Performs the procedure frequently PRACTICE MAKES PERFECT

Exposure considering bony & soft tissues Reduce soft tissue dissection Post approach preserving piriformis Don’t take trochanter off Repair soft tissues

Avoid trochanteric problems Minimising Complications Avoid trochanteric problems Reduce dislocations Avoid sepsis

Using modern techniques & instrumentation Acetabulum Femur

ACETABULUM Circumferential view

Circumferential view Exposure of cancellous bone ACETABULUM Circumferential view Exposure of cancellous bone

Circumferential view Exposure of cancellous bone Rim cutter ACETABULUM Circumferential view Exposure of cancellous bone Rim cutter

RIM CUTTER

Exposure of cancellous bone High pressure lavage & dry ACETABULUM Circumferential view Exposure of cancellous bone Rim Cutter High pressure lavage & dry

Primary Exeter Cemented Prosthesis : Socket Lavage

Exposure of cancellous bone High pressure lavage & dry ACETABULUM Circumferential view Exposure of cancellous bone Rim Cutter High pressure lavage & dry Iliac suction

Iliac Sucker

ACETABULUM Circumferential view Exposure of cancellous bone Rim Cutter High pressure lavage & dry Ilial suction Cement pressurisation

Primary Exeter Cemented Prosthesis : Pressurizing Cement

Primary Exeter Cemented Prosthesis : New Cup Insertion

ACETABULUM Circumferential view Exposure of cancellous bone Rim Cutter High pressure lavage & dry Ilial suction Cement pressurisation Flanged socket, highly crosslinked poly

The Socket Contemporary technique Primitive technique

FEMUR Good exposure

FEMUR Good exposure Clean & Dry Canal

Gun insertion of cement FEMUR Good exposure Clean & Dry Canal Gun insertion of cement

Gun insertion of cement FEMUR Good exposure Clean & Dry Canal Gun insertion of cement Pressurisation

FEMUR Good exposure Clean & Dry Canal Gun insertion of cement Pressurisation Delayed insertion of a polished stem, collarless & double-tapered

FEMUR

Primary Exeter Cemented Prosthesis : Femoral Cementing

Post-op 11yrs

12yrs Post-op

Cemented THA with a polished stem – up to 33 years follow-up

Survivorship curve of the original polished Exeter stems - 1970-75: end point revision for aseptic stem loosening S u r v I o s h p % Survivorship 93.14%: 95% C.L. 74.39-100% Survivorship 93.14%: 95% C.L. 74.39-100% Years since operation

Survivorship curve of the original polished Exeter stems 1970- 75: patients under age 60 at operation. End point revision for aseptic stem loosening S u r v I o s h p % Survivorship 87.22%: 95%CL 54.55 – 100% (68 cases) Survivorship 87.22%: 95%CL 54.55 – 100% (68 cases) Years since operation

Original cups 1970-75; survivorship with end-point revision for aseptic cup loosening S u r v I o s h p % Survivorship 72.45%: 95%CL 39.12-100% Survivorship 72.45%: 95%CL 39.12-100% Years since operation

A 12-17 YEAR SURVIVORSHIP STUDY OF THE EXETER UNIVERSAL CEMENTED STEM This paper describes the 12 year results using the Exeter Universal stem.

100% stem survival at 10 – 17 yrs

CEMENTED EXETER THA IN PATIENTS AGED 50 OR LESS 10 to 17 year follow-up O

DETAILS OF YOUNG HIP REVIEW Patients 107 Bilateral arthroplasties 23 TOTAL No. HIPS: 130 Follow-up: Range: 10 – 17 years Average: 12.5 years No case lost to follow-up Died of unrelated causes: 7 hips

DETAILS OF YOUNG HIP REVIEW Mean age at Sx 42yrs

12 REVISIONS LOOSE STEMS 0 LOOSE CUPS 9 (6.8%) CUP FOR LYSIS 1 RECURRENT DISL 1 INFECTION 1 LOOSE STEMS 0

Here is the survivorship line for the stem with an end-point of re-operation for aseptic stem loosening.

WHAT MAKES A WELL-CEMENTED THA? Excellent technique with a tried & tested prosthesis

Thank you for your attention