Aims: This study assesses the reliability of a new classi-þcation system for the periprosthetic femoral fractures. Methods: Forty (40) radiographs were evaluated by 6 observers, 2 expert, 2 hip fellows and 2 higher trainees. Each observer read the radiographs on 2 separate occasions (four weeks interval between the two readings) and classiþed each case as to its type. Four fracture types are described in this classiþcation system (GS, GU, BS, BU), according to bone quality (Good or Bad) and prosthesis stability (Stable or Unstable). Anatomical location is independently considered (rule of thirds). Speciþc radiographic criteria have been employed to access bone quality and prosthesis stability. Reliability was assessed by an independent statistician looking at the intra-observer and inter-observer agreement and using the κ (Kappa) statistic. Results: All data collected were subject to analysis using Cohenñs weighted kappa statistic. Stats Direct version 1.9.1 to measure the level of agreement between two observers. The results of the intra observer reliability testing showed a mean kappa value of 0.57 with a standard error of 0.29. The overall mean for the inter-reliability was 0.57 with a standard error of 0.28. Conclusion: The results indicate nearly substantial intra and inter-observer agreement. We suggest that the proposed classiþcation system for periprosthetic femoral fractures is reliable.

The aim of this study was to determine the medium term survivorship and function of the cemented Exeter Universal Hip Replacement when used in younger patients.

Since 1988 The Exeter Hip Research Unit has prospectively gathered data on all patients who have had total hip replacements at the Princess Elizabeth Orthopaedic Hospital.

There were 88 Exeter Universal total hip replacements (THR) in 71 patients who were 50 years or younger at the time of surgery and whose surgery was performed at least 10 years before. 25 surgeons performed the surgery. Mean age at surgery was 43 years (range 24 to 50 years. ) 5 patients who had 7 THRs had died leaving 81 THRs for review. Patients were reviewed in clinic at an average of 11. 4 years (10 – 13 years). No patient was lost to follow up.

At review, 8 hips had been revised. 5 cases were for loose cemented metal backed acetabular prosthesis. Two femoral components were revised for infection and one for aseptic loosening. Radiographs showed that a further 10 (13%) acetabular prosthesis were loose and that 3 femurs showed significant osteolysis. Overall 10-year survivorship of stem and cup from all causes was 93%. The 10-year survivorship of stem only from all causes was 98% and from aseptic loosening was 99%.

The Exeter Universal Stem performs extremely well in the younger patient. However the high failure rate of the cemented metal backed Exeter acetabular component has compromised the overall results in this series.