The Exeter Universal Stem has limited published data with greater than 10 year results, this is from specialist orthopaedic centres using predominantly posterior approach. Our aim was to establish whether the published results could be reproduced in a District General Hospital (DGH) using a Hardinge approach. We reviewed 131 consecutive primary THRs implanted into 127 patients between 1995 and 1997 (minimum10 year follow up). Surgery was performed through a Hardinge approach using the Exeter universal stem with the Ogee Elite acetabular component. Outcome was assessed by patient review, completing an Oxford Hip Score (OHS) and reviewing the hospital records. Deceased patients’ hospital records were reviewed and their GP questioned. 5 of 131 hips required revision: 3 for infection at 4–7 years following implantation and 2 for aseptic loosening (one acetabulum only, one both components). There have been no cases of dislocation or sciatic nerve palsy. Kaplan-Meir survival analysis demonstrates ten year survival as follows: 95.3% survival with revision for any cause as the end point; 98.9% with revision for aseptic loosening of the stem as the endpoint, 98.1% with revision for aseptic loosening of the acetabular component as the endpoint, 97.2% with revision for infection as the endpoint. The mean OHS was 22.7 (median =20, interquartile range 15–26). This is the first series to report on the 10 year results with the Exeter Universal stem used exclusively in conjunction with the Ogee Elite acetabular component. It is also the first series to report the 10 year results using only the Hardinge approach. Our findings are the first to show that the Exeter universal stem in combination with the Ogee Elite acetabular component can be inserted through a Hardinge approach in a DGH setting with results comparable to surgery performed in a specialist unit and through a posterior approach.
Most centres cross-match between 2 and 4 units of blood preoperatively for primary Total Hip Arthroplasties (THA), but is this necessary? We aimed to quantify the use of blood after THA in our centre, and to advocate a safe, evidence-based protocol for its use. We looked at the blood requirements of 118 consecutive THAs over a 6 month period. Records of all patients were analysed. Mean pre-operative Hb levels for both males and females were within the normal range. All patients had post-operative blood checks. Results showed that 345 units were cross-matched, but only 114 units (33%) were used. Only 28 of the 114 units (24%) were transfused on the day of surgery. 0% of patients needed intra-operative transfusion, or blood urgently. We conclude that blood should not be routinely cross-matched for primary THA. We advocate a policy of only group and saving of blood in the majority of patients that undergo primary THA, and cross-matching of blood if and when needed. However, the 1–2% of patients that have antibodies present in the blood should have blood cross-matched and available pre-operatively. If needed urgently, O-negative blood can be used or with modern cross-matching techniques, ABO compatible blood can be available from a grouped sample within 5-10 minutes. This is a method sanctioned by the British Blood Transfusion Society, and validated in the literature. Over one year this could save our trust up to £40,000 per year without compromising patient safety.
