We reviewed 142 consecutive primary hip arthroplasties using the Exeter Universal femoral stem implanted between 1988 and 1993 into 123 patients. 74 patients with 88 hips survived to 10 years or more and were reviewed with a mean 12 years 8 months. There was no loss to follow-up and the fate of all stems is known.

Our stem revision rate for aseptic loosening and osteolysis was 1.1% (1 stem); stem revision for any cause was 2.2% (2 stems); and re-operation for any cause was 21.6% (19 hips), all but 2 of which were due to cup failure.

All but one stem subsided within the cement mantle to an average of 1.5mm at final follow-up (0 to 8mm). One stem was revised for deep infection and one was revised for excessive periarticular osteolysis. One further stem had subsided excessively (8mm) and demonstrated lucent lines at the stem-cement and cement-bone interfaces. This was classified as a radiological failure and is awaiting revision. 28% of stems had cement mantle defects, which were associated with increased subsidence (p=0.01), but were not associated with endosteal lysis or stem failure.

Periarticular osteolysis was significantly related with the degree of polyethylene wear (p<0.001), which was in turn associated with younger age patients (p=0.01) and males (p<0.001).

The Exeter metal backed cups were a catastrophic failure with 34% revised (11 cups) for loosening. The Harris Galante cups failed with excessive wear and osteolysis, with failure to revision of 18%. Only 1 cemented Elite cup was revised for loosening and osteolysis (4%).

The Exeter Universal stem implanted outside the originator centre has excellent medium term results.

We have determined the 10 year life expectancy of 5,831 patients who had undergone 6,653 elective primary total hip replacements (THR) at a regional orthopaedic centre between April 1993 and October 2004.

Methods: We ascertained dates of deaths for all those who had undergone surgery during this period and constructed Kaplan Meier survivorship curves for these patients. Standardized mortality ratios were calculated by comparing this data with available UK mortality rates for the same age groups over the same time period.

Results: The mean age at operation was 73 with a male to female ratio of 2:3. Of those with 10 year follow up 29.5% had died a mean of 5.6 years after surgery. 10-year survivorship was 89% in patients under 65 years at surgery, 75% in patients aged between 65 – 74 years and 51% in patients over 75.

The standard mortality rates were significantly higher than expected for patients under 45 years, 20% higher for those between 45 and 64 years and progressively less than expected for patients aged 65 and over.

Discussion: By comparing our mortality curves with prosthesis survivorship curves from the most recent Swedish Arthroplasty Register results we were able to demonstrate that the survivorship of cemented hip arthroplasties exceeds that of the patients over the age of 60 in our area. As these prostheses are less expensive than their uncemented equivalents this suggests these are the prosthesis of choice in this age group.

We determined the 10 year life expectancy of 5,831 patients who had undergone 6,653 elective primary total hip replacements (THR) at a regional orthopaedic centre between April 1993 and October 2004. Using Hospital, General Practitioner (GP) and the local health authority’s records, we determined dates of deaths for all those who had undergone surgery during this period.

The mean age at operation was 73 (13–96) with a male to female ratio of 2:3. Of those with 10 year follow up 29.5% had died a mean of 5.6 (0–11.1) years after surgery. Using Kaplan Meier curves, 10-year survivorship was 89% in patients under 65 years at surgery, 75% in patients aged between 65 – 74 years and 51% in patients over 75.

The standardised mortality rates (SMR) were significantly higher than expected for patients under 45 years, 20% higher for those between 45 and 64 years and progressively less than expected for patients aged 65 and over.

The survivorship of cemented hip arthroplasties (derived from the Swedish Arthroplasty Register 2004) exceeds patients’ life expectancy in those over the age of 60 in our area suggesting that this is the procedure of choice in this population.

The success of total hip replacement in the young has consistently been worse both radiologically and clinically when compared to the standard hip replacement population.

Methods: We describe the clinical and radiological outcome of 58 consecutive polished tapered stems (PTS) in 47 patients with a minimum of 10 years follow up (mean 12 years 6 months) and compared this to our cohort of standard patients. There were 22 CPT stems and 36 Exeter stems.

Results: Three patients with 4 hips died before 10 years and one hip was removed as part of a hindquarter amputation due to vascular disease. None of these stems had been revised or shown any signs of failure at their last follow-up. No stems were lost to follow up and the fate of all stems is known. Survivorship with revision of the femoral component for aseptic loosening as the endpoint was zero and 4% (2 stems) for potential revision. The Harris hip scores were good or excellent in 81% of the patients (mean score 86).

All the stems subsided within the cement to a mean total of 1.8mm (0.2–8) at final review. There was excellent preservation of proximal bone and an extremely low incidence of loosening at the cement bone interface. Cup failure and cup wear with an associated periarticular osteolysis was a serious problem. 19% of the cups (10) were revised and 25% of the hips (13) had significant periarticular osteolysis associated with excessive polyethylene wear.

Discussion: The outcome of polished tapered stems in this age group is as good as in the standard age group and superior to other non PTS designs in young patients. This is despite higher weight and frequent previous surgery. Cup wear and cup failure were significantly worse in this group, with a higher incidence of periarticular osteolysis.