When you’re considering a major operation such as a knee or hip replacement, the chances are you’re reading around the subject, considering where you might choose to have you operation, and looking at the different approaches favoured by different surgeons.
Knee and hip replacement specialist Mr Bridle favours the Exeter femoral stem approach to hip replacements, which is a cemented, polished tapered stem hip replacement. The polished finish has been shown to allow transfer of load from the stem to the cement and bone, allowing the cement to secure the component to the bone and preserving the bone density. The stem has a long pedigree, having been used since the 1960s. Its extensive use in the decades that have passed since it was first introduced, show that the Exeter system has proved itself to be durable and robust.
How do younger patients fare with joint replacements such as these?
One concern for younger patients is that once they have undergone a joint replacement operation, they are likely to put their new joint under more strain than if the operation was done in a more elderly patient.
Recent research published by the Bone and Joint Journal looks at the longevity of hips replaced in patients who were under 40 at the time that they underwent the operation using the cemented Exeter femoral system. The research looks at how they have fared up to 20 years post operatively.
The study shows a very low rate of loosening of the component, with very few patients requiring further operations’, it concludes that “the Exeter femoral component continues to function satisfactorily in young patients for up to 17 years after surgery”. These results compare very favourably with other systems, including cementless components.
Younger patients can be reassured that with advances such as this in joint replacement technology, and the wealth of experience of surgeons such as Mr Bridle, the longevity of joints that are replaced in younger patients is encouragingly good.
Cemented versus cementless stems in hip replacement
The stem in the thigh bone can be fixed with or without cement. If cement is not used, the bone needs to grow onto the component to fix it. Both these approaches do work. The data suggests there may be a higher early failure rate when cement is not used – there is a risk of breaking the femur putting the stem in and of the component not bonding, both of which would require further surgery. There is no evidence that patients function any differently in the longer term with cemented compared with cementless stemmed joints.
One of the reasons the Exeter system is favoured by surgeons such as Mr Bridle is the adaptability that the range of joint implants available offers to the surgeons, and ultimately the patient. This scope and flexibility is simply not available with most other hip replacement systems.
As with all elements of patient care, surgeons will make choices based on the best possible outcome for their patients. The anatomical diversity offered by the Exeter femoral stem system is why it continues to be Mr Bridle’s favoured approach. He understands the importance of ensuring these choices are made in perfect alignment with the patient’s needs, as this gives any new joint the best chance of improving quality of life.