Fujita Hiroshi, Katayama Naoyuki, Iwase Toshiki, Otsuka Hiromi
Department of Orthopedic Surgery, Kyoto Katsura Hospital, Institute for Joint Replacement, Yamada-hirao-cho, Nishikyo-ku, Kyoto 615-8256, Japan.
J Orthop Sci. 2012 Jul;17(4):370-6. doi: 10.1007/s00776-012-0237-5. Epub 2012 May 3.
The Exeter stem was introduced to the Japanese market in 1996. Since then, owing to excellent clinical results, the number of stems used has increased year by year and more than 2000 stems were implanted in 2009. The objective of this study was to prove the efficacy of the Exeter stem for Japanese patients by evaluating the short-term results of four major dedicated hip centers.
We performed a retrospective study of clinical and radiographic results of 1000 primary total hip arthroplasties (THA) performed using the Exeter stem on 881 patients who were followed-up for at least 2 years after surgery. The average age of the patients at operation was 62.3 years (range 23-89 years). Mean postoperative follow-up period was 4.0 (range 2-9) years.
Thirty postoperative complications were observed, including 9 infections, 14 dislocations, 5 cases of deep vein thrombosis, and 2 cases of sciatic nerve palsy. No symptomatic pulmonary embolization or femoral fractures were observed. Re-operations for infection and dislocation were performed in 8 and 6 hips, respectively. According to Barrack's classification, the postoperative cementing grade was judged as A for 735 hips, B for 246 hips, and C for 4 hips. At final follow-up, no radiolucent line was observed at the bone-cement interface. Cortical hypertrophy was observed in 9.5 % of cases in Gruen zones 2-6. Kaplan-Meier survival analysis predicted 100 % survival at 5 years when a radiolucent line at the bone-cement interface of the femur was used as the endpoint, 98.8 % when re-operation was required for any reason.
This study revealed that excellent short-term results were achieved by fixing the Exeter stem with modern cementing techniques for primary THA in Japanese patients.
埃克塞特（Exeter）柄于1996年引入日本市场。自那时起，由于临床效果出色，其使用数量逐年增加，2009年植入数量超过2000柄。本研究的目的是通过评估四个主要专业髋关节中心的短期结果，证明埃克塞特柄对日本患者的疗效。
我们对881例患者行1000例初次全髋关节置换术（THA）使用埃克塞特柄的临床和影像学结果进行了回顾性研究，这些患者术后至少随访2年。患者手术时的平均年龄为62.3岁（范围23 - 89岁）。术后平均随访时间为4.0年（范围2 - 9年）。
观察到30例术后并发症，包括9例感染、14例脱位、5例深静脉血栓形成和2例坐骨神经麻痹。未观察到有症状的肺栓塞或股骨骨折。分别对8髋和6髋因感染和脱位进行了再次手术。根据巴拉克（Barrack）分类，术后骨水泥固定等级判断为：735髋为A级，246髋为B级，4髋为C级。在最后随访时，骨水泥界面未观察到透光线。在Gruen分区2 - 6中，9.5%的病例观察到皮质肥厚。以股骨骨水泥界面的透光线作为终点，Kaplan - Meier生存分析预测5年生存率为100%；因任何原因需要再次手术时，生存率为98.8%。
本研究表明，采用现代骨水泥技术固定埃克塞特柄用于日本患者的初次THA，可获得出色的短期结果。
