Press-fit fixation of uncemented acetabular components is increasingly being used for total hip replacement (THR) surgery. This study was aimed to analyse the survival of an established, un-cemented flexible metal backed cup with non-highly cross-linked polyethylene in primary and simple revision THR.

We assessed the outcome of 1703 consecutive cementless elastic acetabular cups (Atlas, FH France) with non-highly cross-linked polyethylene (GUR1030) in total hip replacement surgery. There were 1582 patients (513 males and 1079 females) with mean age of 74 years (36–97 years). Seventeen senior operating surgeons accounted for 88.5% of cases from a single arthroplasty unit. Survival analysis was calculated using the Kaplan Meier Estimator. At 184 months post surgery the survivorship was 92.4% (95% CI 88.3–94.7) with cup revision for any cause as an endpoint. Three patients died within first month of surgery and 268 patients (17.13%) died due to unrelated causes.

Overall, 59 patients had revisions (3.5%), Thirty eight patients (2.3%) were due to acetabular causes such as: aseptic loosening in 6 patients (0.35%); hip instability in 13 patients (0.76%); and deep infection in 11 patients (0.64%).

We believe the cementless elastic acetabular cup on in total hip replacement is tolerant of technique and patient variation and continues to give excellent long-term results and its continued widespread use can be recommended.

National Institute of Clinical Excellence (NICE) recommended total hip replacement (THR) surgery for fit patients with fracture neck of femur (NOF) in 2011. Our hospital implemented hip fracture program to follow these recommendations the same year. However, the increased incidence of further procedures compared with those undergoing the THR for osteoarthritis alone has led to concern regarding dislocation and other complications when using THR treatment for fracture NOF particularly with the posterior approach.

We introduced dual mobility implant for THR for hip fracture program patients to minimize risk of hip instability but allowing the use of the posterior approach which is recognised as giving a faster recovery than the Hardinge type approaches in this patient group. The Arthroplasty database for hip fracture program was reviewed from September 2011 to September 2015 for appropriateness of this treatment. During this period, 120 Dual Mobility THRs were carried out in 119 patients (36 males, 84 females) with mean age at 78 years (42–94) and average follow-up of 24 months (2–56 months). All patients were either operated by a fellowship trained arthoplasty surgeons or the senior surgeons using posterior approach. All patients undergoing THR for NOF were found to meet the NICE guidelines criteria for THR. No post-operative dislocation, infection, hetotropic ossification or lysis was recorded. Mean Harris Hip Score (HHS) at 19 months was 82 (54–98). In this cohort 112 patients (94.3%) were able to ambulate in non-trendlenburg gait pattern. One patient developed deep vein thrombosis in early post-operative period.

This study emphasises beneficial use the dual mobility implant combined with the posterior approach in THR for fracture NOF patients and highlights the areas of improvements in hip fracture management.