Introduction: Peri-prosthetic osteolysis due to wear has been acknowledged as a major challenge to long-term survival of hip arthroplasty and this has led to a search for alternative articular bearing couples. We present our experience with metal-on-metal (Metasul^®) articulation with a minimum patient follow-up of 5 years.

Materials and methods: 193 patients (215 hips) were reviewed; 187 (209 hips) had a follow-up of ≥ 5 years. Hip scores were completed and radiographs performed at follow-up visits and data was entered prospectively into software (orthocom) designed by Sulzer Ltd.. Serial radiographs were reviewed retrospectively along with hospital notes and the database.

Results: mean age was 70 (± 7.46) years (range 47–86 years). Female: male was 143:44. Most common pre-operative diagnoses were: osteoarthritis (147) and intra-capsular hip fracture (22).

Mean pre-operative HHS was 39.7 (±15.7) and the corresponding pain score was 13.4 (±8.49). The average post-operative scores were 89.5, 87.3, 88.4 and 85.8 at 1 year, 3 years, 5 years and final follow-up respectively. The corresponding pain scores were 42.7, 41.98, 42.1 and 41.94. Implant survival for the cohort as a whole was 95.5% at 12 years (ci: 88%–100%). Survivorship for the Weber Metasul cup was 93.4% at 12 years (ci: 82.7%–100%) and for armor cup was 100% at 11 years.

Complications included: dislocations (7), periprosthetic fractures (8), deep infection- early (3) & late (3), aseptic loosening (cup) (2) & heterotopic ossification (9). There were no untoward systemic complications with regards to metal ion release.

Discussion: We believe that second generation metal-on-metal implants (Metasul^®) with improved design and better lubrication show better survival with regards to aseptic loosening and reduction in osteolysis in the medium-term. Concerns regarding metal ion and metal particle release remain theoretical but are kept under constant review.

Introduction: There has been a renewed interest in metal-on-metal articulation in hip joint Arthroplasty. The reason for having metal-on-metal articulation is to reduce the volume of wear particles that are produced with THR. The outcome of reduced particle formation will hopefully be reduced osteolysis.

Methods: We reviewed the results of 139 primary hip arthroplasties (130 patients) performed using Metasul articulation and cemented Weber cup. Six patients were lost to follow-up leaving 133 hips (124 patients) for review with at least 5-year follow-up. The acetabular socket was the cemented Weber cup and Bone grafting of the acetabulum and application of a reinforcement ring was done where necessary. Cemented CF-30 femoral stem was used in all patients but one (PFMR). The study was conducted retrospectively based on the information collected from hospital notes and Orthocom database. Immediate post-operative films were seen to measure the cup and stem inclination and quality of cementing using the Barracks grading system.

Results: There were 102 females and 22 males in the cohort. Mean age was 73 years (SD-7.46, range 58–86). Left to right hip ratio was 52:81. Most common Pre-operative diagnosis was Osteoarthritis (103) followed by Intracapsular fracture neck of femur (20). The average follow-up was 7.23 years (range 5–10.9). Mean pre-operative Harris hip score was 42.09 and mean post-operative hip scores were 90.01, 86.84, 87.42 and 84.63 at 1-year, 3-year, 5-year and final follow-up with the corresponding pain scores were 42.9, 41.84, 41.56 and 41.56 respectively. Only two hips were revised for aseptic loosening of the cup with a 93.4% implant survivorship at 12 years. There was no case of aseptic stem loosening. No untoward systemic effects were noted in the cohort.

Discussion: We believe that in our study Metasul metal-on-metal articulation has shown satisfactory results with regards to aseptic loosening and reduction in osteolysis in medium-term.

Introduction: Aseptic loosening is the major cause of implant failure. In cemented hip Arthroplasty it is well known that the acetabular side fails earlier due to lysis caused by wear particles. This is the rationale for Hybrid hip Arthroplasty. It might be advantageous to use a bearing which has a low wear rate. The purpose of this study is present the medium term results of this Uncemented cup with a metal-on-metal bearing.

Methods: We reviewed the results of 119 hips (101 patients) who had the Uncemented Fitmore® cup (Sulzer/Zimmer Orthopaedics, Inc). In 66 out of the 101 patients the femoral component used was CF-30® (Sulzer/Zimmer Orthopaedics, Inc) used with cement. In 35 patients Thrust plate prosthesis TPP® (Sulzer/Zimmer Orthopaedics, Inc) was used. This is a bolt type device which is fixed on to the neck; the femoral canal is not violated. Of the 101 patients, 90(108 hips) were available for study. All had minimum of 5 years follow-up.

Results: Mean follow-up of the 90 patients is 87.4 months (range 60 – 129 months). The mean pre-op Harris hip score is 38.2. The mean post-op Harris hip score is 89.6 at the last follow up. Taking aseptic loosening as the end point the survival rate of the Fitmore cup is 100% at 11 years. Four cups were revised for other causes.

Discussion: Histological studies of retrieved metal-on-metal implants have always shown low volume of inflammatory tissue. Wear rate of metal-on-metal hips is 60–100 times lower than metal-on-polyethylene hips. In the medium to long term Uncemented cups fare better than cemented cups. It might be advantageous to use an Uncemented cup with a metal-on-metal bearing. This follow-up study which has a 100% survival rate at 11 years proves that.