ALL-CAUSE CONSTRUCT REOPERATION (INCLUDING FIXATION FOR POSTOPERATIVE PERIPROSTHETIC FEMORAL FRACTURE) OF THE FIRST 1,000 EXETER V40 FEMORAL STEMS PERFORMED AT THE PRINCESS ELIZABETH ORTHOPAEDIC CENTRE, EXETER

The Exeter V40 femoral stem is a cemented polished taper-slip, stainless steel design, introduced in 2000 and the most used femoral component in the National Joint Registry (NJR). The NJR has reported excellent long-term revision outcomes for constructs using the stem combined with many acetabular components. Recent studies have highlighted the high proportion of post-operative peri-prosthetic femoral fractures (POPFF) treated with fixation rather than revision and therefore not included in NJR annual reports. We aimed to review the first 1000 hip replacements using this stem to estimate the all-cause construct survival including fixation for POPFF. We reviewed the first 1016 constructs using an Exeter V40 femoral stem recorded in the Exeter hip database between December 2000 and October 2004. Individual patient records were reviewed for all patients. Patients were censored either at death, revision, fracture fixation, or at the time of the most recent review with evidence of the original hip being in situ. The mean age at primary operation was 69.6 years (range 38, 96) with 58.5% patients reported as female. 35.7% of cases had a consultant as the lead surgeon. Seven cup designs were used as part of the construct with 60.9% using a contemporary flanged acetabular component. 32 patients underwent revision of any part of the construct (including four for POPFF) and 16 underwent fixation of a POPFF. Four Vancouver A fractures were identified and were all managed without surgery. All-cause construct failure including fixation for POPFF using Kaplan-Meier at 10 years was 2.0% (95%CI 1.1, 3.0) and at 20 years was 7.1% (95%CI 4.9, 9.2). The Prosthesis Time Incident Rate (PTIR) for all-cause failure was 3.39 failures per 1000 prostheses years at risk when fixation for POPFF was included, compared to 2.28 failures per 1000 prosthesis years when it was not. When fixation of POPFF is included as an endpoint, the survival of the Exeter V40 femoral stem in this cohort of 1000 patients remains well within NICE benchmarks.