Objectives. Our primary aim was to describe migration of the Exeter stem with a 32 mm head on highly crosslinked polyethylene and whether this is influenced by age. Our secondary aims were to assess functional outcome, satisfaction, activity, and bone mineral density (BMD) according to age. Patients and Methods. A prospective cohort study was conducted. Patients were recruited into three age groups: less than 65 years (n = 65), 65 to 74 years (n = 68), and 75 years and older (n = 67). There were 200 patients enrolled in the study, of whom 115 were female and 85 were male, with a mean age of 69.9 years (sd 9.5, 42 to 92). They were assessed preoperatively, and at three, 12 and, 24 months postoperatively. Stem migration was assessed using Einzel-Bild-Röntgen-Analyse (EBRA). Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), EuroQol-5 domains questionnaire (EQ-5D), short form-36 questionnaire (SF-36,) and patient satisfaction were used to assess outcome. The Lower Extremity Activity Scale (LEAS), Timed Up and Go (TUG) test, and activPAL monitor (energy expelled, time lying/standing/walking and step count) were used to assess activity. The BMD was assessed in Gruen and Charnley zones. Results. Mean varus/valgus tilt was -0.77⁰ and axial subsidence was -1.20 mm. No significant difference was observed between age groups (p ⩾ 0.07). There was no difference according to age group for postoperative WOMAC (p ⩾ 0.11), HHS (p ⩾ 0.06), HOOS (p ⩾ 0.46), EQ-5D (p ⩾ 0.38), patient satisfaction (p ⩾ 0.05), or activPAL (p ⩾ 0.06). Patients 75 years and older had a worse SF-36 physical function (p = 0.01) and physical role (p = 0.03), LEAS score (p < 0.001), a shorter TUG (p = 0.01), and a lower BMD in Charnley zone 1 (p = 0.02). Conclusion. Exeter stem migration is within normal limits and is not influenced by age group. Functional outcome, patient satisfaction, activity level, and periprosthetic BMD are similar across all age groups. Cite this article: N. D. Clement, M. Bardgett, K. Merrie, S. Furtado, R. Bowman, D. J. Langton, D. J. Deehan, J. Holland. Cemented Exeter total hip arthroplasty with a 32 mm head on highly crosslinked polyethylene: Does age influence functional outcome, satisfaction, activity, stem migration, and periprosthetic bone mineral density? Bone Joint Res 2019;8:275–287. DOI: 10.1302/2046-3758.86.BJR-2018-0300.R1

There is continued debate as to whether cemented or cementless implants should be utilized in particular cases based upon chronological age. This debate has been rekindled in the UK and other countries by directives mandating certain forms of acetabular and femoral component fixation based exclusively on the chronological age of the patient. This editorial focuses on the literature-based arguments to support the use of cementless total hip arthroplasty (THA), while addressing potential concerns surrounding safety and cost-effectiveness.

Cite this article: Bone Joint Res. 2019;8(12):604–607.

We report the outcome of 320 primary Total Hip Arthroplasties (THA) with minimum 10-year follow-up (range 10–17 years, mean 12.6 years), performed by a single surgeon in Tauranga New Zealand, with the Exeter Contemporary Flanged all-polyethylene cup and Exeter femoral stem via a posterior approach. The aim of the study is to compare the results with the published results from the design centre and create a baseline cohort for further outcomes research in this centre. All patients were prospectively followed at 6 weeks, 1 year, 5 years, 10 years, (and 15 years when available). Of 333 cases that matched the inclusion criteria, 13 procedures in 12 patents were excluded because of concomitant bone grafting and/or supplementary cage fixation, leaving 320 primary THA procedures in 280 patients, including 26 bilateral procedures in 13 patients. Mean follow-up of the surviving cases was 12.6 (range 5.0-17.1) years. There were 12 revisions – 2 for fracture, 5 for instability, 1 for impingement pain and 4 for infection. There were no revisions for aseptic cup loosening. Kaplan-Meier survivorship with revision for aseptic loosening as the endpoint was 100% at 15.0 years (with minimum 40 cases remaining at risk). All-cause acetabular revision in 12 cases result in a Kaplan-Meier survival of 95.9% (95% CI: 93.5 to 98.3%). Cemented THA with the Exeter Contemporary Flanged cup and the Exeter stem is a durable combination with results that can be replicated outside of the design centre. The Exeter Contemporary Flanged cup has excellent survivorship at 15 years when used with the Exeter stem. Cemented THA with well-proven components should be considered the benchmark against which newer designs and materials should be compared

Abstract. Cemented total hip arthroplasty (THA) in the younger patient has historically been associated with higher wear and revision rates. We carried out a retrospective study of a prospectively collected database of patients at Wrightington hospital undergoing cemented THA under 55 years of age to determine acetabular wear and revision rates. Between August 2005 and December 2021 a cohort of 110 patients, 56 males and 54 females, underwent Cemented Total Hip Replacement through a posterior approach. Mean age at operation was 50yrs (35–55). The mean follow up was 6 years 9 months (0–16 years). 3 patients were lost to follow-up. Of the remaining 107 patients, Conventional and cross lined polyethylene were used in 54 and 53 patients respectively. Ceramic heads were used in 102 patients. 22.225mm and 28mm heads were used in 60 and 47 patients respectively. Clinical outcomes were assessed by Merle d'Aubigne and Postel scores which showed significant functional improvement. Linear wear was measured on plain radiographs using TRAUMA CAD and cup loosening was assessed by classification of Hodgkinson et al. No cases were revised during the observed follow up period. The mean wear rate in conventional and crosslinked polyethylene cups were 2.31mm (0.1–4.6) and 1.02mm (0.1–2.6) respectively. Cemented THA with both conventional and crosslinked polyethylene provides excellent survival rates in adults under the age of 55 years and crosslinked polyethylene may further improve these results due to improved wear rates

Our objective was to examine revision rates and patient reported outcome scores (PROMS) for cemented and uncemented primary total knee joint replacement (TKJR) at six months, one year and five years post-operatively. Patients and Methods: This matched cohort study involved secondary analyses of data collected as part of a large prospective observational study monitoring outcomes following knee replacement in Christchurch, New Zealand. Cemented and uncemented TKJR participants (n = 1526) were matched on age (± 5 years), sex and body mass index (BMI). From this larger sample, PROMS data, Oxford Knee Score and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), out to five years post-operatively were analysed for a matched subset of participants (n = 252). The average age of participants was 67.9 years (SD 9.4, range 38-94). There were no differences between cemented and uncemented cohorts on the basis of age, sex, BMI or comorbidities, revision rates or PROMS outcomes. Cemented procedures had greater skin to skin times than uncemented procedures (p < 0.01). Unadjusted outcomes comparing risk for revision across the two participant cohorts did not significantly differ. Overall rates for revision were low (cemented 3.2% v uncemented 2.7%, p=0.70). Propensity adjusted associations between baseline characteristics (age, sex, BMI, comorbidity, baseline Oxford and baseline WOMAC scores) also revealed no differences in risk for revision at any post-operative timepoint. In this large multi-surgeon matched cohort study there were no significant differences in functional outcomes or revision rates, when outcomes following modern cemented and uncemented TKJR were compared out to 5-year follow up. Based on our findings, uncemented TKJR is predictable irrespective of patient's age, BMI or gender

Aims. Total hip arthroplasty (THA) is a very successful and cost-effective operation, yet debate continues about the optimum fixation philosophy in different age groups. The concept of the 'cementless paradox' and the UK 'Getting it Right First Time' initiative encourage increased use of cemented fixation due to purported lower revision rates, especially in elderly patients, and decreased cost. Methods. In a high-volume, tertiary referral centre, we identified 10,112 THAs from a prospectively collected database, including 1,699 cemented THAs, 5,782 hybrid THAs, and 2,631 cementless THAs. The endpoint was revision for any reason. Secondary analysis included examination of implant survivorship in patients aged over 70 years, over 75 years, and over 80 years at primary THA. Results. Cemented fixation had the lowest implant survival in all age groups, with a total ten-year survivorship of 97.0% (95% confidence interval (CI) 95.8 to 97.8) in the cemented group, 97.6% (95% CI 96.9 to 98.1) in the hybrid group, and 97.9% (95% CI 96.9 to 98.6) in the cementless group. This was not statistically significant (p = 0.092). There was no age group where cemented fixation outperformed hybrid or cementless fixation. Conclusion. While all fixation techniques performed well at long-term follow-up, cemented fixation was associated with the lowest implant survival in all age groups, including in more elderly patients. We recommend that surgeons should carefully monitor their own outcomes and use fixation techniques that they are familiar with, and deliver the best outcomes in their own hands. Cite this article: Bone Joint J 2022;104-B(2):206–211

Aims. Uncemented mobile bearing designs in medial unicompartmental knee arthroplasty (UKA) have seen an increase over the last decade. However, there are a lack of large-scale studies comparing survivorship of these specific designs to commonly used cemented mobile and fixed bearing designs. The aim of this study was to evaluate the survivorship of these designs. Methods. A total of 21,610 medial UKAs from 2007 to 2018 were selected from the Dutch Arthroplasty Register. Multivariate Cox regression analyses were used to compare uncemented mobile bearings with cemented mobile and fixed bearings. Adjustments were made for patient and surgical factors, with their interactions being considered. Reasons and type of revision in the first two years after surgery were assessed. Results. In hospitals performing less than 100 cases per year, cemented mobile bearings reported comparable adjusted risks of revision as uncemented mobile bearings. However, in hospitals performing more than 100 cases per year, the adjusted risk of revision was higher for cemented mobile bearings compared to uncemented mobile bearings (hazard ratio 1.78 (95% confidence interval 1.34 to 2.35)). The adjusted risk of revision between cemented fixed bearing and uncemented mobile bearing was comparable, independent of annual hospital volume. In addition, 12.3% of uncemented mobile bearing, 20.3% of cemented mobile bearing, and 41.5% of uncemented fixed bearing revisions were for tibial component loosening. The figures for instability were 23.6%, 14.5% and 11.7%, respectively, and for periprosthetic fractures were 10.0%, 2.8%, and 3.5%. Bearing exchange was the type of revision in 40% of uncemented mobile bearing, 24.3% of cemented mobile bearing, and 5.3% cemented fixed bearing revisions. Conclusion. The findings of this study demonstrated improved survival with use of uncemented compared to cemented mobile bearings in medial UKA, only in those hospitals performing more than 100 cases per year. Cemented fixed bearings reported comparable survival results as uncemented mobile bearings, regardless of the annual hospital volume. The high rates of instability, periprosthetic fractures, and bearing exchange in uncemented mobile bearings emphasize the need for further research. Cite this article: Bone Joint J 2021;103-B(7):1261–1269

Source of the study: University of Auckland, Auckland, New Zealand. Unicompartmental knee arthroplasty (UKA) is effective for patients with isolated compartment osteoarthritis, however the procedure has higher revision rates. Long-term survivorship and accurate characterisation of revision reasons are limited by a lack of long-term data and standardised revision definitions. We aimed to identify survivorship, risk factors and revision reasons in a large UKA cohort with up to 20 years follow-up. Patient, implant and revision details were recorded through clinical and radiological review for 2,137 consecutive patients undergoing primary medial UKA across Auckland, Canterbury, Counties Manukau and Waitematā DHB between 2000 and 2017. Revision reasons were determined from review of clinical, laboratory, and radiological records for each patient using a standardised protocol. To ensure complete follow-up data was cross-referenced with the New Zealand Joint Registry to identify patients undergoing subsequent revision outside the hospitals. Implant survival, revision risk and revision reasons were analysed using Cox proportional-hazards and competing risk analyses. Implant survivorship at 15 years was comparable for cemented fixed-bearing (cemFB; 91%) and uncemented mobile-bearing (uncemMB; 91%), but lower for cemented mobile-bearing (cemMB; 80%) implants. There was higher incidence of aseptic loosening with cemented implants (3–4% vs. 0.4% uncemented, p<0.01), osteoarthritis (OA) progression with cemMB implants (9% vs. 3% cemFB/uncemMB; p<0.05) and bearing dislocations with uncemMB implants (3% vs. 2% cemMB, p=0.02). Compared with the oldest patients (≥75 years), there was a nearly two-fold increase in risk for those aged 55–64 (hazard ratio 1.9; confidence interval 1.1-3.3, p=0.03). No association was found with gender, BMI or ASA. Cemented mobile-bearing implants and younger age were linked to lower implant survivorship. These were associated with disease progression and bearing dislocations. The use of cemented fixed-bearing and uncemented mobile-bearing designs have superior comparable long-term survivorship

The initial success of modern total hip arthroplasty can in large part be attributed to the reliable fixation of the femoral component with the use of acrylic bone cement. Early success with cement led to a common pathway of development in North America and the European countries. Much of the early to mid-term research concentrated on refinement of variables related to the methodology and technique of cement fixation. Scandinavian registries were subsequently able to report on improved survivorship with better cementing technique. The net effect has been standardisation towards a small number of cemented implants with good long-term outcomes representing the majority of stems implanted in Sweden, for example. In North America, during the mid-term development of THA in the late 1980's, the term “cement disease” was coined and the cemented THA saw a precipitous decline in use, now to the point where many American orthopaedic residents are completing training never having seen a cemented THA. Modern uncemented femoral components can now claim good long-term survivorship, perhaps now comparable to cemented fixation. However, this has come at a cost with respect to the premium expense applied to the implant itself as well as lineage of failed uncemented constructs. The last several years have seen a proliferation of uncemented implants, usually at a premium cost, with no demonstrated improvement in survivorship. Osteolysis has not been solved with uncemented implants and cement disease has largely been recognised as a misnomer. Long-term outcomes of cemented femoral fixation have consistently demonstrated excellent survivorship, even in the younger age group. Cemented stems allow for variable positioning of the stem to allow for better soft tissue balancing, without the need for proximal modularity. Cemented stems are more forgiving and fail less often secondary to a reduced incidence of intra-operative complications, such as peri-prosthetic fracture. Cemented stems tend to be less expensive and also have the advantage of adding antimicrobial agents into the cement. This is important in emerging markets. The next iteration of orthopaedic innovation driven by the emerging markets may indeed be back to the future. Key Points: The initial success of total hip arthroplasty was based on cemented femoral fixation. Long-term outcomes in the United States demonstrate good results for cemented femoral fixation. Despite this, cemented fixation is not frequently used in the United States. Results from multiple national joint replacement registries demonstrate superior long-term performance of cemented femoral fixation. European countries, perhaps because of the excellent results in the national registries, use cemented femoral fixation more often than not. Cemented femoral fixation is cost neutral if not less expensive and allows for the addition of antimicrobials. Cemented femoral fixation is perhaps easier to perform as the component can be potted in a range of positions as opposed to the position being dictated by the femoral anatomy

Although data on uncemented short stems are available, studies on cemented short-stemmed THAs are limited. These cemented short stems may have inferior long-term outcomes and higher femoral component fracture rates. Hence, we examined the long-term follow-up of cemented short Exeter stems used in primary THA. Within the Exeter stem range, 7 stems have a stem length of 125 mm or less. These stems are often used in small patients, in young patients with a narrow femoral canal or patients with anatomical abnormalities. Based on our local database, we included 394 consecutive cemented stems used in primary THA (n=333 patients) with a stem length ≤125 mm implanted in our tertiary referral center between 1993 and December 2021. We used the Dutch Arthroplasty Registry (LROI) to complete and cross-check the data. Kaplan-Meier survival analyses were performed to determine 20-year survival rates with stem revision for any reason, for septic loosening, for aseptic loosening and for femoral component fracture as endpoints. The proportion of male patients was 21% (n=83). Median age at surgery was 42 years (interquartile range: 30–55). The main indication for primary THA was childhood hip diseases (51%). The 20-year stem survival rate of the short stem was 85.4% (95% CI: 73.9–92.0) for revision for any reason and 96.2% (95%CI: 90.5–98.5) for revision for septic loosening. No stems were revised for aseptic femoral loosening. However, there were 4 stem fractures at 6.6, 11.6, 16.5 and 18.2 years of follow-up. The stem survival with femoral component fracture as endpoint was 92.7% (CI: 78.5–97.6) at 20 years. Cemented short Exeter stems in primary THA show acceptable survival rates at long-term follow-up. Although femoral component fracture is a rare complication of a cemented short Exeter stem, orthopaedic surgeons should be aware of its incidence and possible risk factors

The initial success of modern total hip arthroplasty can in large part be attributed to the reliable fixation of the femoral component with the use of acrylic bone cement. Early success with cement led to a common pathway of development in North America and the European countries. Much of the early- to mid-term research concentrated on refinement of variables related to the methodology and technique of cement fixation. Scandinavian registries were subsequently able to report on improved survivorship with better cementing technique. The net effect has been standardisation towards a small number of cemented implants with good long-term outcomes representing the majority of stems implanted in Sweden, for example. In North America, during the mid-term development of THA in the late 1980's, the term “cement disease” was coined and the cemented THA saw a precipitous decline in use, now to the point where many American orthopaedic residents are completing training never having seen a cemented THA. Modern uncemented femoral components can now claim good long-term survivorship, perhaps now comparable to cemented fixation. However, this has come at a cost with respect to the premium expense applied to the implant itself as well as lineage of failed uncemented constructs. The last several years have seen a proliferation of uncemented implants, usually at a premium cost, with no demonstrated improvement in survivorship. Osteolysis has not been solved with uncemented implants and cement disease has largely been recognised as a misnomer. Long-term outcomes of cemented femoral fixation have consistently demonstrated excellent survivorship, even in the younger age group. Cemented stems allow for variable positioning of the stem to allow for better soft tissue balancing, without the need for proximal modularity. Cemented stems are more forgiving and fail less often secondary to a reduced incidence of intraoperative complications, such as periprosthetic fracture. Cemented stems tend to be less expensive and also have the advantage of adding antimicrobial agents into the cement. This is important in emerging markets. The next iteration of orthopaedic innovation driven by the emerging markets may indeed be back to the future

Stems may improve fixation and stability of components during revision total knee replacement. However, the choice between cemented and cementless stems is not a clear one. Cemented stems offer several advantages in terms of versatility, mechanical stability, surgical technique and clinical outcome over their cementless counterpart. Cite this article: Bone Joint J 2014;96-B(11 Suppl A):115–7

Introduction. Revision total knee arthroplasty (TKA) is becoming increasingly common in the United States as the population ages and larger numbers of primary TKA are performed in younger individuals. Cemented or uncemented tibial stems are frequently used in revision cases. Decreased clinical outcomes and patient satisfaction have been described for revision TKA. This study aims to determine if the presence of overall pain and tibial pain at the end of the stem differs between cemented and uncemented tibial stems in revision TKA. Methods. This was a retrospective cohort study comparing patients who underwent revision TKA utilizing cemented or uncemented tibial stems in a 15-year period at a single institution with at least two-year follow-up. Exclusion criteria included age under 18, isolated revisions of the femoral component or polyethylene exchanges, lack of preoperative or postoperative imaging, insufficient operative or implant records available for electronic chart review, revision procedures performed at outside facilities, patients who were deceased at the time of survey administration, refusal to participate in the study, and failure to return the mailed survey or respond to a telephone follow-up questionnaire. Radiographic analysis included calculation of the percentage of the tibial canal filled with the implant, as well as measurement of the diameter of the tibial stem. Radiographs were also reviewed for evidence of cavitary defects, pedestal formation, radiolucent lines, and periprosthetic fractures. Mailed surveys addressing overall pain, tibial pain, and satisfaction were analyzed using Fisher's exact test and the independent sample t-test. Logistic regression was used to adjust for age, gender, and preoperative bone loss. Results. A total of 110 patients were included (63 cemented and 47 uncemented stems). No statistically significant differences in stem length, operative side, or indications for revision were found. The uncemented group had a significantly higher percent canal fill (p < 0.0001). Tibial pain at the end of the stem was present in 25.3% of cemented stems and 25.5% of uncemented stems (p = 1.00). There was a trend towards more overall pain in the uncemented cohort, but this did not reach statistical significance. Only 74.6% of cemented patients and 78.7% of uncemented patients were satisfied following revision TKA (p = 0.66). Conclusion. The data supports our hypothesis that there are no differences in end-of-stem pain or overall pain between cemented and uncemented tibial stems in revision TKA. High rates of dissatisfaction were noted in both cohorts postoperatively, consistent with previous literature. Patient factors likely play a large role in the presence of postoperative pain. These factors should be further evaluated in future studies in an effort to reduce pain and improve patient satisfaction

Aims. To evaluate the outcomes of cemented total hip arthroplasty (THA) following a fracture of the acetabulum, with evaluation of risk factors and comparison with a patient group with no history of fracture. . Patients and Methods. Between 1992 and 2016, 49 patients (33 male) with mean age of 57 years (25 to 87) underwent cemented THA at a mean of 6.5 years (0.1 to 25) following acetabular fracture. A total of 38 had undergone surgical fixation and 11 had been treated non-operatively; 13 patients died at a mean of 10.2 years after THA (0.6 to 19). Patients were assessed pre-operatively, at one year and at final follow-up (mean 9.1 years, 0.5 to 23) using the Oxford Hip Score (OHS). Implant survivorship was assessed. An age and gender-matched cohort of THAs performed for non-traumatic osteoarthritis (OA) or avascular necrosis (AVN) (n = 98) were used to compare complications and patient-reported outcome measures (PROMs). Results. The mean time from fracture to THA was significantly shorter for patients with AVN (2.2 years) or protrusio (2.2 years) than those with post-traumatic OA (9.4 years) or infection (8.0 years) (p = 0.03). Nine contained and four uncontained defects were managed with autograft (n = 11), bulk allograft (n = 1), or trabecular metal augment (n = 1). Initial fracture management (open reduction and internal fixation or non-operative), timing of THA (> /< one year), and age (> /< 55 years) had no significant effect on OHS or ten-year survival. Six THAs were revised at mean of 12 years (5 to 23) with ten-year all-cause survival of 92% (95% confidence interval 80.8 to 100). THA complication rates (all complications, heterotopic ossification, leg length discrepancy > 10 mm) were significantly higher following acetabular fracture compared with atraumatic OA/AVN and OHSs were inferior: one-year OHS (35.7 versus 40.2, p = 0.026); and final follow-up OHS (33.6 versus 40.9, p = 0.008). . Conclusion . Cemented THA is a reasonable option for the sequelae of acetabular fracture. Higher complication rates and poorer PROMs, compared with patients undergoing THA for atraumatic causes, reflects the complex nature of these cases. Cite this article: Bone Joint J 2017;99-B:1399–1408

Durable humeral component fixation in shoulder arthroplasty is necessary to prevent painful aseptic loosening and resultant humeral bone loss. Causes of humeral component loosening include stem design and material, stem length and geometry, ingrowth vs. ongrowth surfaces, quality of bone available for fixation, glenoid polyethylene debris osteolysis, exclusion of articular particulate debris, joint stability, rotator cuff function, and patient activity levels. Fixation of the humeral component may be achieved by cement fixation either partial or complete and press-fit fixation. During the past two decades, uncemented humeral fixation has become more popular, especially with short stems and stemless press fit designs. Cemented humeral component fixation risks difficult and complicated revision surgery, stress shielding of the tuberosities and humeral shaft periprosthetic fractures at the junction of the stiff cemented stem and the remaining humeral shaft. Press fit fixation may minimise these cemented risks but has potential for stem loosening. A randomised clinical trial of 161 patients with cemented vs. press fit anatomic total shoulder replacements found that cemented fixation of the humeral component provided better quality of life, strength, and range of motion than uncemented fixation but longer operative times. Another study found increased humeral osteolysis (43%) associated with glenoid component loosening and polyethylene wear, while stress shielding was seen with well-fixed press fit humeral components. During reverse replacement the biomechanical forces are different on the humeral stem. Stem loosening during reverse replacement may have different factors than anatomic replacement. A systemic review of 41 reverse arthroplasty clinical studies compared the functional outcomes and complications of cemented and uncemented stems in approximately 1800 patients. There was no difference in the risk of stem loosening or revision between cemented and uncemented stems. Uncemented stems have at least equivalent clinical and radiographic outcomes compared with cemented stems during reverse shoulder arthroplasty. Durable humeral component fixation in shoulder arthroplasty is associated with fully cemented stems or well ingrown components that exclude potential synovial debris that may cause osteolysis

Cemented total hip replacement (THR) provides excellent outcomes and is cost-effective. Polished taper-slip (PTS) stems demonstrate successful results and have overtaken traditional composite-beam (CB) stems. Recent reports indicate they are associated with a higher risk of postoperative periprosthetic femoral fracture (PFF) compared to CB stems. This study evaluates risk factors influencing fracture characteristics around PTS and CB cemented stems. Data were collected for 584 PFF patients admitted to eight UK centres from 25/05/2006-01/03/2020. Radiographs were assessed for Unified Classification System (UCS) grade and Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) type. Statistical comparisons investigated relationships by age, gender, and stem fixation philosophy (PTS versus CB). The effect of multiple variables was estimated using multinomial logistic regression to estimate odds ratios (OR) with 95% confidence intervals (CI). Median (IQR) age was 79.1 (72.0–86.0) years, 312 (53.6%) patients were female, and 495 (85.1%) stems were PTS. The commonest UCS grade was type B1 (278, 47.6%). The commonest AO/OTA type was spiral (352, 60.3%). Metaphyseal-split fractures occurred only with PTS stems with an incidence of 10.1%. Male gender was associated with a five-fold reduction in odds of a type C fracture (OR 0.22, 95% CI 0.12 to 0.41, p<0.001) compared to a type B fracture. CB stems were associated with significantly increased odds of transverse fracture (OR 9.51, 95% CI 3.72 to 24.34, p <0.001) and wedge fracture (OR 3.72, 95% CI 1.16 to 11.95, p <0.05) compared to PTS stems. This is the largest study investigating PFF characteristics around cemented stems. The commonest fracture types are B1 and spiral fractures. PTS stems are exclusively associated with metaphyseal-split fractures, but their incidence is low. Males have lower odds of UCS grade C fractures compared to females. CB stems had higher odds of bending type fractures (transverse and wedge) compared to PTS stems. Biomechanical testing is needed for validation and investigation of modifiable factors which may reduce the risk of unstable fracture patterns requiring complex revision surgery over internal fixation

Cemented acetabular components commonly have a long posterior wall (LPW). Alternative components have a hooded or offset reorientating geometry, theoretically to reduce the risk of THR instability. We aimed to determine if cemented acetabular component geometry influences the risk of revision surgery for instability or loosening. The National Joint Registry for England, Wales and Northern Ireland (NJR) dataset was analysed for primary THAs performed between 2003 – 2017. A cohort of 224,874 cemented acetabular components were identified. The effect of acetabular component geometry on the risk of revision for instability or for loosening was investigated using binomial regression adjusting for age, gender, ASA grade, diagnosis, side, institution type, operating surgeon grade, surgical approach, polyethylene crosslinking and head size. A competing risk survival analysis was performed with the competing risks being revision for other indications or death. Among the cohort of subjects included, the distribution of acetabular component geometries was: LPW – 81.2%, hooded – 18.7% and offset reorientating – 0.1%. There were 3,313 (1.47%) revision THAs performed, of which 815 (0.36%) were for instability and 838 (0.37%) were for loosening. Compared to the LPW group, the adjusted subhazard ratio of revision for instability in the hooded group was 2.29 (p<0.001) and 4.12 (p=0.047) in the offset reorientating group. Likewise, the subhazard ratio of revision for loosening was 2.43 (p<0.001) in the hooded group and 11.47 (p<0.001) in the offset reorientating group. A time-varying subhazard ratio of revision for instability (hooded vs LPW) was found, being greatest within the first 6 months. This Registry based study confirms a significantly higher risk of revision THA for instability and for loosening when a cemented hooded or offset reorientating acetabular component is used, compared to an LPW component. Further research is required to clarify if certain patients benefit from the use of hooded or offset reorientating components, but we recommend caution when using such components in routine clinical practice

Introduction. Cemented total knee arthroplasty (TKA) remains the gold standard with survivorship above 90% at greater than 10 years postoperatively. However, with younger, heavier, more active patients undergoing TKA at an increasing rate, cementless implants have the appeal of potential for improved implant fixation longevity and decreased rates of aseptic loosening. The cementless implants are more expensive than their cemented counterparts such that implant costs may create a barrier to utilization. However, such comparisons fail to consider the unavoidable additional costs of cementing, including the cost of operating room time, cement and cementing accessories. The purpose of this study is to compare the actual cost of cemented and cementless TKA. Methods. The TKA cost calculation included the cost of operative time, implants, cement and cementing accessories. The difference in operative time between cemented and cementless TKA was determined from a previously published study of 100 TKAs performed using a cemented (55) or press fit (45) implant of the same design performed at a single institution by four fellowship trained arthroplasty surgeons. The decision to use cemented or cementless design in these patients was made based on patient bone quality intraoperatively. Operative time was compared between groups using a Student's two-tailed T-test. The cost of operating room time was based on estimates in the recent literature. The cost of cement and cementing accessories was estimated based on publically available market data. The cost of implants was estimated from institutional data for multiple companies. Results. The cost comparison between cemented and cementless total knee arthroplasty is summarized in Table 1. Mean operative time for cemented TKA was 14.3 minutes longer than for cementless TKA (94.7 + 15.2 vs. 80.4 + 15.7, p<0.01). The estimated cost of one minute of operating room time in the literature ranges from $30 to $60. For our analysis, we used an estimate of $36 per minute obtained from a recently published multi-center study. This resulted in an average operating room time cost $3406 for cemented and $2894 for cementless TKA. Antibiotic cement costs an average of $250 per bag and antibiotic-free cement costs an average of $75 per bag. Cement mixing techniques vary across surgeons. Approximately 95% use a vacuum system and 5% use a mixing bowl. The cost of vacuum systems ranges from $80 for an enclosed bowl to $125 for a vacuum system that can be directly connected to a cement gun. The cost of a plastic mixing bowl and spatula is $20. The cost of the disposables from a cement injection kit is $25. The average cost of a primary TKA implant, including femoral, tibial and polyethylene liner components, is $3530 for cemented and $4659 for cementless designs. Patellar resurfacing is not routinely used at our institution and therefore was not included in implant cost. Based on our calculations, the average cost of a cementless TKA is $7553. Using the cheapest cementing technique with 2 bags of plain cement and a manual mixing bowl with spatula, the cost of a cemented TKA $7114. Using the most expensive cementing technique with 2 bags of antibiotic cement and a cement gun compatible vacuum mixer, the cost of a cemented TKA is $7564. Conclusion. Cemented TKA remains the gold standard and still accounts for most procedures. Cementless TKA is increasing in utilization and may decrease the rate of aseptic loosening, especially in the rapidly growing young, active population undergoing TKA. Although cementless implants remain more expensive than cemented implants at most institutions, the actual overall cost of the two procedures is similar if operative time, cement and cementing accessories are considered. For any figures or tables, please contact authors directly

Conventional cemented acetabular components are reported to have a high rate of failure when implanted into previously irradiated bone. We recommend the use of a cemented reconstruction with the addition of an acetabular reinforcement cross to improve fixation. We reviewed a cohort of 45 patients (49 hips) who had undergone irradiation of the pelvis and a cemented total hip arthroplasty (THA) with an acetabular reinforcement cross. All hips had received a minimum dose of 30 Gray (Gy) to treat a primary nearby tumour or metastasis. The median dose of radiation was 50 Gy (Q1 to Q3: 45 to 60; mean: 49.57, 32 to 72). . The mean follow-up after THA was 51 months (17 to 137). The cumulative probability of revision of the acetabular component for a mechanical reason was 0% (0 to 0%) at 24 months, 2.9% (0.2 to 13.3%) at 60 months and 2.9% (0.2% to 13.3%) at 120 months, respectively. One hip was revised for mechanical failure and three for infection. Cemented acetabular components with a reinforcement cross provide good medium-term fixation after pelvic irradiation. These patients are at a higher risk of developing infection of their THA. . Cite this article: Bone Joint J 2015;97-B:177–84

Background. The acknowledged benefit of the direct anterior (DA) approach is early functional return. Most surgeons in the U.S. use cementless femoral replacement given the negative track record of some cemented designs. However, delayed osseointegration of a femoral stem typically seen in older patients with poor bone quality will delay recovery, diminishing the benefits of the DA approach. Registry studies have shown a higher revision rate and complications in this patient population leading to a renewed interest in cemented fixation. Questions posed. To achieve the functional benefits of the DA approach and the fixation benefits of cemented replacement, this study combined the 2 techniques posing the following questions:1) Does the limited access of the DA approach adversely affect the cement technique? 2) Does such a cementing technique reduce the incidence of cementless complications?. Methods. A consecutive series of 341 patients (360 hips) receiving the DA approach between 2016–2018 were reviewed. There were 203 cementless stems and 157 cemented stems. Mean age was 75 in the cementless group and 76 in the cemented group, 70% females. Femoral complications were compared between the 2 groups using the T-test. Results. The cementless group had a higher rate of femoral complications (8 versus 0, P=0.011). There were 2 loose stems and 6 fractures, all requiring revision. Fractures occurred about 14.5 days and loosening about 10 months postoperatively. Conclusion. A higher rate of complications occurred with cementless stems. Cemented stems are protective in patients above 70 and can be safely done through the DA approach

Aims

Dislocation remains a leading cause of failure following revision total hip arthroplasty (THA). While dual-mobility (DM) bearings have been shown to mitigate this risk, options are limited when retaining or implanting an uncemented shell without modular DM options. In these circumstances, a monoblock DM cup, designed for cementing, can be cemented into an uncemented acetabular shell. The goal of this study was to describe the implant survival, complications, and radiological outcomes of this construct.

Polished taper-slip (PTS) cemented stems have an excellent clinical track record and are the most common stem type used in primary total hip arthroplasty (THA) in the UK. Due to low rates of aseptic loosening, they have largely replaced more traditional composite beam (CB) cemented stems. However, there is now emerging evidence from multiple joint registries that PTS stems are associated with higher rates of postoperative periprosthetic femoral fracture (PFF) compared to their CB stem counterparts. The risk of both intraoperative and postoperative PFF remains greater with uncemented stems compared to either of these cemented stem subtypes. PFF continues to be a devastating complication following primary THA and is associated with high complication and mortality rates. Recent efforts have focused on identifying implant-related risk factors for PFF in order to guide preventative strategies, and therefore the purpose of this article is to present the current evidence on the effect of cemented femoral stem design on the risk of PFF.

Cite this article: Bone Joint J 2024;106-B(1):11–15.

Total knee replacement (TKA) is one of the most successful procedures in orthopaedic surgery. Although originally limited to more elderly and less active individuals, the inclusion criteria for TKA have changed, with ever younger, more active and heavier patients receiving TKA. This broadening of indications coincided with the widespread adoption of modular cemented and cementless TKA systems in the 1980's, and soon thereafter wear debris related osteolysis and associated prosthetic loosening became major modes of failure for TKA implants of all designs. Initially, tibial components were cemented all polyethylene monoblock constructs. Subsequent long-term follow-up studies of some of these implant designs have demonstrated excellent durability in survivorship studies out to twenty years. While aseptic loosening of these all polyethylene tibial components was a leading cause of failure in these implants, major polyethylene wear-related osteolysis around well-fixed implants was rarely (if ever) observed. Cemented metal-backed nonmodular tibial components were first introduced to allow for improved tibial load distribution and protection of the underlying (often osteoporotic) bone. Eventually, modularity between the polyethylene tibial component and the metal-backed tray was introduced in the mid-80s mainly to facilitate screw fixation for cementless implants. These designs also provided intraoperative versatility by allowing interchange of various polyethylene thicknesses, and also aided the addition of stems and wedges. Modular vs. All Polyethylene Tibial Components in Primary TKA: Kremers et al. reviewed 10,601 adult (>18 years) patients with 14,524 condylar type primary TKA procedures performed at our institution between 1/1/1988 and 12/31/2005 and examined factors effecting outcome. The mean age was 68.7 years and 55% were female. Over an average 9 years follow-up, a total of 865 revisions, including 252 tibia revisions were performed, corresponding to overall survival of 89% (Confidence intervals (CI): 88%, 90%) at 15 years. In comparison to metal modular designs, risk of tibial revision was significantly lower with all polyethylene tibias (HR 0.3, 95% CI: 0.2, 0.5). With any revision as the endpoint, there were no significant differences across the 18 designs examined. Similarly, there were no significant differences across the 18 designs when we considered revisions for aseptic loosening, wear, osteolysis. Among patient characteristics, male gender, younger age, higher BMI were all significantly associated with higher risk of revisions (p<0.008). In a more recent review from our institution of over 11, 600 primary TKA procedures, Houdek et al. again showed that all polyethylene tibial components had superior survivorship vs. metal backed designs, with a lower risk of revision for loosening, osteolysis or component fracture. Furthermore, results for all polyethylene designs were better for all BMI subgroups except for those <25 BMI where there was no difference. All polyethylene results were also better for all age groups except for those under age <55 where there again was no difference. Finally, in a recently published meta-analysis of 28 articles containing data on 95,847 primary TKA procedures, all polyethylene tibial components were associated with a lower risk of revision and adverse outcomes. The available current data support the use of all polyethylene tibial designs in TKA in all patients regardless of age and BMI. In all patients, (not just older individuals) use of an all polyethylene tibial component is an attractive and more cost effective alternative, and is associated with the better survivorship and lower risk of revision than seen with modular metal backed tibial components

Introduction. Cemented stems have given good results with no difference in outcome when comparing taper slip and composite beam designs in short-term randomised trials. We aimed to ascertain differences in outcome between the different cemented design philosophies using a large-scale registry analysis. Materials and Methods. A retrospective cohort study of National Joint Registry of England and Wales (NJREW) was conducted. The study population included all primary total hip operations performed in the UK from 1 April 2003 to 31 September 2012. All cemented stems were identified and categorised as taper slip (polished) or composite beam (non-polished). Results. Non-polished stems accounted for 16.6% of all primary cemented hip replacements with polished stems making up the remainder. Mean age for non-polished stems was 73.0 years and 71.8 for the polished group (p<0.001) suggesting selection bias. There was a statistically significant increased chance of revision in the non-polished group compared with the polished group (p<0.001). Reasons for revision by fixation type:. Reason for revision. Total. Polished n=253667. Non-polished n=50661. N. %. n. %. Aseptic loosening stem. 532. 300. 0.12. 232. 0.46. Infection. 965. 735. 0.29. 230. 0.45. Stem lysis. 149. 99. 0.04. 50. 0.10. Cup lysis. 156. 125. 0.05. 31. 0.06. Malalignment stem. 114. 86. 0.03. 28. 0.06. The risk of aseptic loosening, stem lysis, malalignment and infection were several magnitudes higher for non-polished stems than for polished varieties (p<0.05). Discussion. Theoretical concerns are reflected in clinical practice with an increased incidence of revision for non-polished stems for all indications recorded. Conclusions. Incidence of revision is higher in cemented non-polished stems compared with polished designs

Aims

Periprosthetic fractures (PPFs) following hip arthroplasty are complex injuries. This study evaluates patient demographic characteristics, management, outcomes, and risk factors associated with PPF subtypes over a decade.

Femoral revision in cemented THA might include some technical difficulties, based on loss of bone stock and cement removal, which might lead to further loss of bone stock, inadequate fixation, cortical perforation or consequent fractures. Cemented THA has become an extremely successful operation with excellent long-term results. Although showing decreasing popularity in North America, it always remained a popular choice for the elderly patients in Europe and other parts of the world. Various older and recent studies presented excellent long-term results, for cemented fixation of the cup as well as the stem. Besides optimal component orientation, a proper cementing technique is of major importance to assure longevity of implant fixation. Consequently a meticulous bone bed preparation assures the mechanical interlock between the implant component, cement and the final bone bed. Pre-operative steps as proper implant sizing/ templating, ensuring an adequate cement mantle thickness, and hypotensive anaesthesia, minimizing bleeding at the bone cement interface, are of major importance. Additionally, femoral impaction grafting, in combination with a primary cemented stem, allows for femoral bone restoration due to incorporation and remodeling of the allograft bone by the host skeleton. Historically, it has been first performed and described in Exeter in 1987, utilizing a cemented tapered polished stem in combination with morselised fresh frozen bone grafts. The technique was refined by the development of designated instruments, which have been implemented by the Nijmegen group from Holland. Indications might include all femoral revisions with bone stock loss, while the Endo-Clinic experience is mainly based on revision of cemented stems. Cavitary bone defects affecting meta- and diaphysis leading to a wide or so called “drain pipe” femora, are optimal indications for this technique, especially in young patients. Contraindications are mainly: septical revisions, extensive circumferential cortical bone loss and noncompliance of the patient. The cement mantle is of importance, as it acts as the distributor of force between the stem and bone graft and seals the stem. A cement mantle of at least 2 mm has shown favorable results. Originally the technique is described with a polished stem. We use standard brushed stems with comparable results. Relevant complications include mainly femoral fractures due to the hardly impacted allograft bone. Subsidence of tapered polished implants might be related to cold flow within the cement mantle, however, could also be related to micro cement mantle fractures, leading to early failure. Subsidence should be less than 5 mm. Impaction grafting might technically be more challenging and more time consuming than cement-free distal fixation techniques. It, however, enables a reliable restoration of bone stock which might especially become important in further revision scenarios in younger patients

Aims

The aim of this retrospective study was to assess the incidence of early periprosthetic femoral fracture (PFF) associated with Charnley-Kerboull (CK) femoral components cemented according to the ‘French paradox’ principles through the Hueter anterior approach (HAA) in patients older than 70 years.

We performed 88 primary ball-and-socket arthroplasties of the trapeziometacarpal joint in 84 patients (69 women and 15 men) with a mean age of 61 years (37 to 81). Cemented de la Caffinière prostheses were implanted in 43 joints from 1988 to 1991 and 45 cementless Ledoux implants were used between 1992 and 1994. Of the 61 surviving prostheses still in situ, 51 were reviewed clinically and radiologically with a mean follow-up of 25 months for the Ledoux and 63 months for the de la Caffinière implant. The survival rate for the Ledoux prosthesis was 58.9% at 16 months and for the de la Caffinière implant 66.4% at 68 months. Loosening occurred in 15% of the Ledoux stems, in 46% of the Ledoux cups, in 24% of the de la Caffinière stems and in 28% of the de la Caffinière cups. Both prostheses behaved similarly, and it is clear that a constrained ball-and-socket prosthesis is not suitable for the trapeziometacarpal joint

Cemented total hip arthroplasty (THA) has become an extremely successful operation with excellent long-term results. Although showing decreasing popularity in North America, it always remained a popular choice for the elderly patients in Europe and other parts of the world. Various older and recent studies presented excellent long-term results, for cemented fixation of the cup as well as the stem. Besides optimal component orientation, a proper cementing technique is of major importance to assure longevity of implant fixation. Consequently a meticulous bone bed preparation assures the mechanical interlock between the implant component, cement and the final bone bed. Preoperative steps as proper implant sizing/ templating, ensuring an adequate cement mantle thickness, and hypotensive anesthesia, minimising bleeding at the bone cement interface, are of major importance. First the fossa pyriformis should be clearly identified, including the posterolateral entry point of the prosthesis. The femoral neck cut is usually 1.5cm to 2cm above the minor trochanter, based on the preoperative planning and implant type. Opening of the canal is done with an awl or osteotome, followed by any blunt tipped instrument, to follow the intramedullary direction. A box osteotome opens the lateral portion of the femoral neck, gently to preserve as much cancellous bone as possible. Sequential broaching follows carefully and according to the planning, to ensure preservation of 2mm to 3mm cancellous bone for interdigitation. Some systems might require over-broaching by one size. Trialing is done with the broach. Following, irrigation using a long nozzle pulsatile lavage, reduces the chance for fat embolism. A cement restrictor is then placed 1.5cm to 2cm distal to the tip of the stem, to ensure an adequate cement mantle distally. A second complete pulsatile irrigation of the canal follows, to minimise bleeding, followed by a dry sponge. Cement mixing is vacuum based in the meantime, usually 60–80g. We prefer the use of low dose antibiotic laden cement in our set up. Two to three minutes after mixing, the cement is applied rapidly in a retrograde technique, with a cement gun placing the nozzle tip against the cement restrictor. The gun is “pushed” out during the application, rather than being withdrawn from the canal. Proximal pressurization is first done by thumb, then with a proximal seal for 1 minute. The stem is inserted slowly using steady manual pressure, in the center of the cement mantle, however should never be impacted. The stem is aligned with the previously defined lateral entry point and is held in position until the cement hardens. The desired outcome is a cement interdigitation into cancellous bone for 2mm to 3mm and an additional mantle of 2mm pure cement

Aims

The aim of this study was to report the three-year follow-up for a series of 400 patients with a displaced intracapsular fracture of the hip, who were randomized to be treated with either a cemented polished tapered hemiarthroplasty or an uncemented hydroxyapatite-coated hemiarthroplasty.

Restoration of an anatomical hip centre frequently requires limb lengthening, which increases the risk of nerve injury in the treatment of Crowe 4 DDH. The objective was to perform a prospective evaluation of SDTSO with Cemented Exeter Femoral Component. 15 female patients (18 hips – 3 bilateral) with a mean age at time of operation of 51 years were followed-up for a mean of 77 months (11 to 133). 16 cemented and 2 uncemented acetabular components were implanted. Exeter cemented DDH stems were used in all cases. No patient was lost to follow-up. Charnley-d'Aubigné-Postel scores for pain, function and range of movement were improved from a mean of 2, 2, 3 to 5, 4, 5 respectively. One osteotomy failed to unite at 14 months and was revised successfully. Clinical healing was achieved at a mean of 6 months and radiological at a mean of 9 months. The mean length of the excised segment was 3cm and the mean true limb lengthening was 2cm. A 3.5mm DCP plate with unicortical screws was used to reduce the osteotomy, and intramedullary autografting was performed in all cases. Mean subsidence was 1mm and no stem was found loose at the latest follow-up. No sciatic nerve palsy was observed and no dislocation. Cemented Exeter femoral components perform well in the treatment of Crowe IV DDH with SDTSO. Transverse osteotomy is necessary to achieve derotation and reduction can be maintained with a DCP plate. Intramedullary autografting prevents cement interposition at the osteotomy site

Cemented acetabular components continue to be used in more than half of the total hip replacements performed in the United Kingdom. The implants are relatively inexpensive but the results rely heavily on precise surgical technique, with restoration of the centre of rotation of the hip and the creation of an equal cement mantle with good pressurisation and penetration of the cement into the bone. The Opera all polyethylene acetabular component was designed with a malleable flange, which could be independently pressurised, a long posterior wall to promote stability and instrumentation which ensured that pressurisation could be maintained throughout the curing process. We present for the first time, the medium-term results of 409 consecutive cemented flanged Opera acetabular components performed in 374 patients. 247 operations were performed via a trochanteric osteotomy and 162 via a posterior approach, using multiple key holes, cement pressurisation and Palacos-R cement. Autograft was used in 32 cases. Cemented femoral components were used in all cases. There were 241 Charnley stems with 22mm heads and 168 polished triple tapered C-stems (146 with 22mm heads and 22 with 26mm heads). The average age at the time of surgery was 68.2 years (32–87) and the average duration of follow-up was 89 months (60–130). 54 patients (56 hips) died during the follow-up period. The acetabulum was assessed using the zones of DeLee and Charnley, and the Hodgkinson classification. There was one temporary femoral nerve palsy, two dislocations and 3 non-fatal pulmonary emboli. Both components were revised in two hips for deep sepsis, and in two hips only the femoral implant was revised, one for a fractured stem and one for aseptic loosening, with the original acetabular components remaining in situ. Of the remaining original acetabular components 6% have shown progressive radiological demarcation, none have migrated, but in two hips there is evidence of rapid wear and the development of osteolysis

Abstract

Introduction: The best method of management of displaced intracapsular femoral neck fractures in elderly patients remains undecided. Most are treated by hemiarthroplasty. Aim: To clarify the issue of whether or not to use cement in hemiarthroplasty for displaced, intracapsular, femoral neck fractures in the elderly. Methods: Consecutive patients with displaced, intracapsular, femoral neck fractures treated by hemiarthroplasty between January 1997 and May 1998, in two hospitals within one region were reviewed. The same monoblock prosthesis was used; in Hospital A they were uncemented (121 patients), and in Hospital B they were cemented (123 patients). All surviving patients (50 and 56 respectively) were interviewed for assessments of pre-fracture and current pain, walking ability, use of walking aids and activities of daily living (ADL), using validated scoring systems. The average follow-up was 36 months. Results: The patients’ demographical data were similar (the mean age was 82 and 84 years respectively). There was no greater incidence of intra-operative fall in diastolic blood pressure or oxygen saturation in the cemented group. Cemented procedures took, on average, 15 minutes longer. Fewer of the cemented group had been revised or were awaiting revision (p=0.036). There was no difference in complication or mortality rates at any time between surgery and follow-up (p=0.86). Prospective assessment revealed highly significant differences in favour of cement, in terms of pain (p=0.003), walking ability (p=0.002), use of walking aids (p=0.004) and ADL (p=0.009). Conclusion: Our findings support the use of cemented hemiarthroplasty for the displaced intracapsular femoral neck fracture in the elderly patient

The use of a cemented implant instead of a spacer has been proposed due to the improved function in comparison with a spacer. Unfortunately the removal of a conventional cemented stem can be challenging. The use of a short cemented stem can overcome this problem. Between July 2011 and May 2013, 10 infected hips were treated with a short cemented stem as a spacer. The infected implants were cemented in 6 cases and cementless in 4 cases. Mean time from index operation was 3 years (range 0 to 8 years). It was the first treatment for infection in all cases. Antibiotic loaded cement and an all-poly cup was used in all cases. The bugs were staph aureus and staph epidermidis in most cases. A Friendly short cemented stem with specific cement restrictor and standard cementing tecnique was used in all cases. This stem has been successfully tested in over 200 patients and approved by TUV to be released on the marked. In all cases, the infection was successfully cured with antibiotics for a period ranging from 3 to 5 months. 2 patients were revised after the infection was cured for recurrent dislocation. No recurrent infection was found at the latest follow up. One stage revision is gaining in popularity for the decreased morbidity and better quality of life of the patients. Weak points of one-stage revision are slightly inferior results in terms of eradication of the infection and the fact that it can be done only with cemented implants. Cemented implants show inferior durability than cementless implants and are difficult to remove if revision is needed. The use of a short cemented stem can couple the advantages of one stage revision and the fact that it is easily removed if this is needed for various reasons (aseptic loosening, recurrent dislocation and periprosthetic fracture). Contraindications to this technique are severe bone loss in the acetabulum or in the proximal femur

The alumina on alumina articulation in THA has induced less macrophage reaction and cytokine section than polyethylene bearings. Thus THA using alumina on almina articulation has induced little periprosthetic osteolysis. However alumina fracture is still a concern. We had underwent 100 THAs that it was a cemented polyethylene backed acetabular component with an alumina inlay(ABS Cup; Kyocera, Kyoto, Japan), PHS stem(Kyocera) and 28mm alumina femoral head. This system was formerly used in only Japan, over 10 years results have not reported yet. We retrospectively reviewed 94 patients(100 hips) with cemented alumina on alumina THAs to identify factors relating to alumina failure, and to evaluate mid-term(>10years) results. 16 patients died from unrelated causes within 10 years of the operation and 14 patients was lost to follow up. The remaining 70 patients(79 Hips) were evaluated after a mean follow-up of 10 years. We performed clinical evaluation using the JOA score, and radiological evaluation was performed that inclination and anteversion angle of cup measurement with 2D template system at anteroposterior radiograph. On the radiographs at the final examination, radiolucency and osteolysis were evaluated around the acetabular component, and around the femoral component. These evaluations were scheduled for 3,6,9, and 12 months and yearly thereafter. All the operations were performed by same surgeon, at same center. Cumulative survival rates were calculated using the Kaplan-Meier method with failure defined as the end point of revision for alumina failure or for any reason. To compare groups with and without alumina failures in age, BMI, gender, activity, function, abduction angle, size of component, or existence of radiolucent lines, we used the nonparametric Mann-Whitney U-test. The mean age of the patients at surgery was 63.0 years. The mean follow up term was 13.8 years. Inclination and anteversion mean angle of cup were 45.6°and 14.2°.ã��Revision surgery was performed because of alumina inlay failure in 4hips(2 fractures and 2 dissociation;5.1%), loosening in 2 hips(2 cup loosenings; 2.5%) recurrent dislocation in 1 hip, and femoral fracture in 1 hip, no deep infection and DVT. The 10-year survival rate was 92.4% with revision for any reason and 95.9% with revision for alumina failure as the end point. We detected 3 ceramic failures at a mean of 8.9 years(4.1ï¼ï¿½12.5) after the index operation. There were no differences in BMI, function, cup angles(inclination and anteversion), and cup loosening among the 4hips with alumina failure. But there were differences in age, gender, and activity with alumina failure. This alumina on alumina THA yielded passably mid-term results, but it was occurred a high rate of catastrophic alumina inlay failure. In July 2000, we discontinued use of this type of THA to avoid alumina failure. This ABS cup was banned in 2002, because of numerous alumina failures. We suggest all patients with this type of acetabular component be followed carefully. Cemented polyethylene-backed alumina-on-alumina THA with a composite of alumina inlay had a relatively high rate of catastrophic alumina inlay failure(5.1ï¼ï¿½) during a mean of 13.8 years' follow up. There were differences in age, gender, and activity with alumina failure

Total knee replacement (TKR) is one of the most successful procedures in orthopaedic surgery. Although originally limited to more elderly and less active individuals, the inclusion criteria for TKR have changed, with ever younger, more active and heavier patients receiving TKR. Currently, wear debris related osteolysis and associated prosthetic loosening are major modes of failure for TKR implants of all designs. Initially, tibial components were cemented all polyethylene monoblock constructs. Subsequent long-term follow-up studies of these implants have demonstrated excellent durability in survivorship studies out to twenty years. Aseptic loosening of the tibial component was one of the main causes of failure in these implants. Cemented metal-backed nonmodular tibial components were subsequently introduced to allow for improved tibial load distribution and to protect osteoporotic bone. Long-term studies have established that many one-piece nonmodular tibial components have maintained excellent durability. Eventually, modularity between the polyethylene tibial component and the metal-backed tray was introduced in the mid-80s mainly to facilitate screw fixation for cementless implants. These designs also provided intraoperative versatility by allowing interchange of various polyethylene thicknesses, and to also aid the addition of stems and wedges. Other advantages included the reduction of inventory, and the potential for isolated tibial polyethylene exchanges as a simpler revision procedure. However, several studies have documented the high failure rate of isolated polyethylene exchange procedures, probably because technical problems related to the original components are left uncorrected. Since the late 1980s, the phenomena of polyethylene wear and osteolysis have been observed much more frequently when compared with earlier eras. The reasons for this increased prevalence of synovitis, progressive osteolysis, and severe polyethylene wear remain unclear, but there is no question that it was associated with the widespread use of both cementless and cemented modular tibial designs. Mayo Data. The study population included 10,601 adult patients with 14,524 primary TKA procedures performed at our institution between 1/1/1988 and 12/31/2005. Mean age was 68.7 years and 55% were female. Overall revision rates and revisions for loosening, wear/osteolysis were compared across different designs. Over an average 9 year follow-up, a total of 865 revisions, including 252 tibia revisions were performed, corresponding to overall survival of 89% (Confidence intervals (CI): 88%, 90%) at 15 years. In comparison to metal modular designs, risk of tibial revision was significantly lower with all-poly tibias (HR 0.3, 95% CI: 0.2, 0.5). Overall, posterior cruciate-retaining designs performed better than the posterior-stabilised designs (p=0.002). With any revision as the endpoint, there were no significant differences across the 18 designs examined. Similarly, there were no significant differences across the 18 designs when we considered revisions for aseptic loosening, wear, and osteolysis. Among patient characteristics, male gender, younger age, and higher BMI were all significantly associated with higher risk of revisions (p<0.008). Summary. Available data support the use of nonmodular tibial designs in TKA in order to prevent or reduce the chance of backside wear, third body particles from resulting metallic debris and associated polyethylene induced osteolysis. In all patients, (not just older individuals) use of an all polyethylene tibial component is an attractive and more cost effective alternative, and is associated with the best survivorship and lowest risk of revision

Introduction: Restoration of an anatomical hip centre frequently requires limb lengthening, which increases the risk of nerve injury in the treatment of Crowe 4 DDH. Objective: Prospective evaluation of SDTSO with Cemented Exeter Femoral Component. Material and Methods: 15 female patients (18 hips – 3 bilateral) with a mean age at time of operation of 51 years followed-up for a mean of 77 months (11 to 133). 16 cemented and 2 uncemented acetabular components were implanted. Exeter cemented DDH stems were used in all cases. No patient lost to follow up. Results: 18 Crowe IV hips. Charnley-D’Aubigne-Postel score for pain, function and range of movement were improved from a mean of 2, 2,3 to 5,4,5 respectively. One osteotomy failed to unite at 14 months and revised successfully. Clinical healing was achieved at a mean of 6 month while radiological at a mean of 9 months. The mean length of the excised segment was 3cm and the mean true limb lengthening was 2cm. 3.5mm DCP plate with unicortical screws was used to reduce the osteotomy, and intramedullary autografting performed in all cases. Mean subsidence was 1mm and no stem was found loose at the latest follow up. No sciatic nerve palsy observed and no dislocation. Conclusion: Cemented Exeter femoral components perform well in the treatment of Crowe IV DDH with SDTSO. Transverse osteotomy is necessary to achieve derotation and reduction can be maintained with a DCP plate. Intramedulary autografting prevents cement interposition at the osteotomy site

The best management of displaced intracapsular femoral neck fractures in the elderly remains undecided. Most are treated by hemiarthroplasty. The aim of this study was to establish whether the advantages of cement outweigh the disadvantages. All patients with displaced intracapsular femoral neck fractures treated with herniarthroplasty between January 1997 and May 1998, in 2 hospitals within the same Deanery, were reviewed. The same prosthesis was used, but in hospital A they were uncemented, and in B cemented. There were 122 patients in hospital A and 123 in B. We conducted a detailed retrospective analysis of hospital notes. All surviving patients (50 and 56 respectively) were interviewed to obtain pre-fracture and current scores of pain, walking ability, use of walking aids, activities of daily living (ADL) and accommodation status, using validated scoring systems. The relative deterioration over the follow-up period (32–36 months) was determined and the groups compared. Patient demographics confirmed comparability of groups. There was no greater incidence of intra-operative fall in diastolic blood pressure, or oxygen saturation in the cemented group. Cemented procedures were on average 15 minutes longer. Median in-patient stay was the same. Significantly fewer of the cemented group had been revised or were awaiting revision (p=0. 036). There was no difference in mortality rates at any point between surgery and follow-up. Prospective assessment of surviving patients revealed highly statistically significant greater deterioration in pain (p=0. 003), walking ability (p=0. 002), use of walking aids (p=0. 003) and ADL (p=0. 009) in the uncemented group. The trend for more dependent accommodation in the uncemented group failed to reach statistical significance (p=0. 14). In conclusion, the cemented group faired significantly better than the uncemented group. Our findings suggest the advantages of cement outweigh the disadvantages, and we support the use of cemented hemiarthroplasty for the displaced intracapsular femoral neck fracture in the elderly patient

The purposes of this study were to report the accuracy of stem anteversion for Exeter cemented stems with the Mako hip enhanced mode and to compare it to Accolade cementless stems.

We reviewed the data of 25 hips in 20 patients who underwent THA through the posterior approach with Exeter stems and 25 hips in 19 patients with Accolade stems were matched for age, gender, height, weight, disease, and approaches. There was no difference in the target stem anteversion (20°–30°) between the groups. Two weeks after surgery, CT images were taken to measure stem anteversion.

The difference in stem anteversion between the plan and the postoperative CT measurements was 1.2° ± 3.8° (SD) on average with cemented stems and 4.2° ± 4.2° with cementless stems, respectively (P <0.05). The difference in stem anteversion between the intraoperative measurements and the postoperative CT measurements was 0.75° ± 1.8° with Exeter stems and 2.2° ± 2.3° with Accolade stems, respectively (P <0.05).

This study demonstrated a high precision of anteversion for Exeter cemented stems with the Mako enhanced mode and its clinical accuracy was better with the cemented stems than that with the cementless stems. Although intraoperative stem anteversion measurements with the Mako system were more accurate with the cemented stems than that with the cementless stem, the difference was about 1° and the accuracy of intra-operative anteversion measurements was quite high even with the cementless stems. The smaller difference in stem anteversion between the plan and postoperative measurements with the cemented stems suggested that stem anteversion control was easier with cemented stems under the Mako enhanced mode than that with cementless stems.

Intraoperative stem anteversion measurement with Mako total hip enhanced mode was accurate and it was useful in controlling cemented stem anteversion to the target angle.

Introduction and Aims: Cemented femoral revision total hip arthroplasty has been associated with early mechanical failure by aseptic loosening. This study was performed to determine the long-term survival of cemented femoral revision arthroplasty and to identify factors predictive of failure. Method: One hundred and twenty-nine cemented femoral revision cases were reviewed to determine component survival. Ninety-seven hips with a minimum follow-up of five years were included for survival analysis and tests of significance. Harris hip scores were used to quantify clinical outcomes. Complete radiographic series were reviewed. Kaplan-Meier survival curves were calculated. Clinical and surgical factors were analysed to determine if they were predictive of failure. Results: Individual Harris hip scores improved to a mean of 71 at the most recent follow-up from a mean pre-operative score of 52 (p< 0.001). Kaplan-Meier survival at 10 years was 91%, with revision for aseptic loosening of the femoral component as the endpoint and 71% with mechanical failure as the endpoint. Patients older than 60 years experienced greater long-term component survival and less pain than patients younger than sixty years (p< 0.05). Good quality post-operative cement mantles were associated with better long-term radiographic fixation (p< 0.001). Poor femoral bone quality was significantly associated with an increased rate of re-revision for aseptic loosening (p=0.021). Conclusion: Revision femoral THA with cement remains an option in selected patients with acceptable 10-year survival and fair radiographic fixation. Patients demonstrated acceptable clinical outcomes at 10 years and few experienced significant pain. The best results may be achieved in older patients with adequate bone stock and modern cementing techniques

Introduction: The information in the literature about the relative merits of cemented and cementless unicompartmental knee replacement (UKR) is contradictory, with some favouring cementless fixation while others favouring cemented fixation. Cemented fixations give good survivorship but there is concern about the radiolucency which frequently develops around the tibial component. The exact cause of the occurrence of radiolucency is unknown but according to some, it may suggest suboptimal fixation. Method: Sixty-two knees (31 in each group) were randomised to receive either cemented or cementless UKR components. The components were similar except that the cementless had a porous titanium and hydroxyappatite (HA) coating. Patients were prospectively assessed by an independent observer pre-operatively and annually thereafter. The clinical assessment included Oxford Knee Score, Knee Society Scores and Tegner activity score. Fluoroscopically aligned radiographs were assessed for thickness and extent of radiolucency under the tibial implant. Results: At one year there were no differences in the clinical outcome between the groups and there were no loose components. No radiolucencies thicker than 1mm were seen. At one year none of the cementless tibias and 30% of the cemented tibias had complete radiolucencies. One out of 31 cementless (3%) and 12 out of 31 cemented (39%) had partial radiolucencies. This difference between these two groups was high significant (p< 0 0001). Conclusions: This study clearly demonstrates that the incidence of radiolucency beneath the tibial component is influenced by component design and method of fixation. With identical designs of tibial component none of the cementless components developed complete radiolucences whereas 30% of the cemented components did. We conclude that HA achieves better bone integration than cement

Joint registries suggest a downward trend in the use of uncemented Total Knee Replacements (TKR) since 2003, largely related to reports of early failures of uncemented tibial and patella components. Advancements in uncemented design such as trabecular metal may improve outcomes, but there is a scarcity of high-quality data from randomised trials.

319 patients <75 years of age were randomised to either cemented or uncemented TKR implanted using computer navigation. Patellae were resurfaced in all patients. Patient outcome scores, re-operations and radiographic analysis of radiolucent lines were compared.

Two year follow up was available for 287 patients (144 cemented vs 143 uncemented). There was no difference in operative time between groups, 73.7 v 71.1 mins (p= 0.08). There were no statistical differences in outcome scores at 2 years, Oxford knee score 42.5 vs 41.8 (p=0.35), International Knee Society 84.6 vs 84.0 (p=0.76), Forgotten Joint Score 66.7 vs 66.4 (p=0.91). There were two revisions, both for infection one in each group (0.33%). 13 cemented and 8 uncemented knees underwent re-operation, the majority of these being manipulation under anaesthetic (85.7%), with no difference (8.3% vs 5.3%, 95% CI -2.81% to 8.89%, p = 0.31). No difference was found in radiographic analysis at 2 years, 1 lucent line was seen in the cemented group and 3 in the uncemented group (0.67% v 2.09%, 95%CI -4.1% to 1.24%, p = 0.29).

We found no difference in clinical or radiographic outcomes between cemented and uncemented TKR including routine patella resurfacing at two years.

Early results suggest there is no difference between cemented and uncemented TKR at 2 years with reference to survivorship, patient outcomes and radiological parameters.

Periprosthetic femoral fracture (PFF) following primary total hip arthroplasty (THA) is of raising concern with the aging of the population. The aim of this retrospective study was to assess the incidence of early PFF associated with Charnley- Kerboull (CK) stems cemented line-to-line according to the “French paradox” principles through the anterior approach (AA) in patients older than 70 years old.

This monocentric study involved 25 surgeons with various level of experience. From a prospectively collected database, all CK stems (AmisK®, Medacta, Castel San Pietro, Switzerland) done consecutively from January 2018 to May 2022 through the AA in patients older than 70 years were included. The measured parameters included canal flare index (CFI), morphological cortical index (MCI), canal-calcar ratio (CCR), ilium-ischial ratio (IIR), ilium overhang, and anterior superior iliac spine (ASIS) to greater trochanter distance. Dorr classification was also recorded.

A total of 416 CK stems performed by 25 surgeons were included. All patients had a minimal 3-month follow-up. The mean age was 77.4 years, and the mean BMI was 25.3 kg/m². According to the Dorr classification 240 hips were of Dorr type A, 144 Dorr type B, and 2 Dorr type C. Mean CFI, MCI, CCR, IIR and ASIS-GT were 3.8, 0.5, 2.8, 2.5, and 101mm, respectively. Amongst the 416 THAs, one (0.24%; 95% CI 0.20 – 0.28%) early PFF Vancouver type B2 fracture that occurred 24 days postoperatively was observed.

This study demonstrated that CK stems cemented according to the “French Paradox” were associated with an extremely low rate of early PFF in patients over 70 years. The observed results are better than those reported with uncemented or taper slip cemented stems. Longer follow-up is warranted to evaluate further rate of fracture that may occur during the bone remodeling process around the femoral component.

Introduction: Cemented stems are still widely used in THA; however, there remain concerns with hip dislocation and wear debris. Restoring joint mechanics is essential for soft tissue balance and reduction of mechanical impingement. These concerns have lead to the development of a modular neck for cemented THA. Material and methods: 200 R-120™ cemented stems were implanted in 190 patients since 2001. The shape of the stem is trapezoidal with a large collar that provides for impaction and compression of the cement. The stem collar is made with a cavity where a self-locking taper and a positive indexing mechanism provide 12 different positions to ensure proper restoration of joint mechanics. One to five years follow up with a mean of 2.8 years. Two-thirds were female and one- third male. Age ranged from 39 to 87 with a mean of 73. Majority was treated for OA. A c.c. head (28mm or 32mm) and poly bearing in a cementless cup were used for all patients. Selection of neck position was recorded for all patients. Results: 635 of all head-neck positions were other than neutral. There were 0 dislocations, no significant leg length discrepancies (+/− 5mm), and 0 infections. There was one stem removed due to a post-op peri-prosthetic fracture at 3 years that was treated with a long cement-less stem. 1 death due to a PE ten days post-op. 1 intra-operative calcar fracture wired and healed uneventfully. 1 intra-op greater trochanter fracture that was treated with screws. 2 neck fractures revised to cementless stems. Conclusions: Modular neck design aids in fine tuning joint mechanics after stem insertion, and allows for ease and access in case of revisions. This modular neck design has eliminated (to date) hip dislocations and we remain optimistic about its long-term potential to improve outcomes. Fatigue properties have been significantly improved and no additional neck fractures have occurred

Introduction. Humeral radiolucent lines after anatomic TSA (aTSA) have been well described; however, little clinical consequences have been attributed to them. The recent emergence of shorter humeral stems has demonstrated higher incidences of humeral radiolucencies than has been reported historically with standard length components. This large scale database analysis quantifies and compares the clinical outcomes of aTSAs with and without radiolucent humeral lines using one specific prosthesis to determine their impact on clinical outcomes. Methodology. This is a multicenter, retrospective, case controlled radiographic and clinical review. Preoperative and postoperative data was analyzed from 671 aTSA patients with a minimum of 2 years followup. 538 of these 671 aTSA patients had full radiographic followup (80.2%) and were included in this study; these patients had an average followup of 45.3 months). 459 patients had noncemented humeral stems; whereas, 79 patients had cemented humeral stems. Radiographs were reviewed at latest follow up for humeral radiolucent lines based on the technique described by Gruen et al. Patients were evaluated and scored pre-operatively and at latest follow-up using the SST, UCLA, ASES, Constant, and SPADI scoring metrics; ROM was also recorded. A Student's two-tailed, unpaired t-test was used to identify differences in pre-operative, post-operative, and improvement in results, where p<0.05 denoted a significant difference. Results. All patients demonstrated significant improvements in pain and function following treatment with the primary shoulder arthroplasty. 14 patients (8 female, avg: 65.6 yrs; 6 male, avg: 61.7 yrs) were observed to have radiolucent lines around the humeral component (2.6%). The rate of humeral radiolucent lines was observed to be significantly higher in patients with cemented (7.6%) vs. noncemented (1.7%) humeral stems (p = 0.0025). Pre-operatively, no difference was noted in any clinical metric score between patients with or without radiolucent humeral lines. (Figure 1) However post-operatively, patients with radiolucent humeral lines had significantly worse ASES (p=0.0087), UCLA (p=0.0371), SST (p=0.0341), and SPADI (p=0.0051) scores (Figure 2) and significantly lower improvements in outcomes according to ASES (p=0.0120) and SPADI (p=0.0247) scores (Figure 3), relative to patients without radiolucent humeral lines. Additionally, radiolucent lines had a more profound effect on cemented stems (as compared to noncemented stems), where cemented stems with radiolucent humeral liners were associated with significantly lower post-operative outcomes and significantly lower improvements in outcomes. Finally, patients with humeral radiolucent lines had a significantly higher complication rate (21.4% vs 4.6%, p = 0.004) as compared to the complication rate of patients without radiolucent humeral lines. Conclusions. The study demonstrated a relatively low incidence of humeral radiolucent lines with anatomic TSA. Cemented stems were associated with a significantly higher rate of humeral radiolucent lines as compared to noncemented stems. Patients whose shoulders had radiolucent humeral lines were associated with significantly lower clinical outcomes and significantly less active ROM as compared to those without radiolucent lines. This diminished outcome was more pronounced with cemented humeral stems. Additional and longer term clinical followup is necessary to confirm the results of this study

Aim: To clarify the issue of whether or not to cement the hemiarthroplasty in the treatment of displaced intra-capsular femoral neck fractures in the elderly. Method: All patients with displaced intracapsular femoral neck fractures treated with hemiarthroplasty between January 1997 and May 1998, in 2 hospitals within the same Deanery, were reviewed. The same prosthesis was used; in hospital A they were uncemented, and in B cemented. There were 121 patients in hospital A and 123 in hospital B; all patients alive at follow-up (50 and 56 respectively) were interviewed for pre-fracture and current assessments of pain and functional ability using validated scoring systems. Follow-up was 32–36 months. Results: Patient demographics were similar. Cemented procedures took 15 minutes longer. In-patient stay was the same. Signiþcantly fewer of the cemented group had been revised or were awaiting revision (p=0.036). There was no difference in mortality rates at any point. Prospective assessment of surviving patients revealed highly statistically signiþcant greater deterioration in pain (p=0.003), walking ability (p=0.002), use of walking aids (p=0.003) and activities of daily living (p=0.009) in the uncemented group. The trend for more dependent accommodation in the uncemented group failed to reach statistical signiþcance (p=0.14). Conclusions: Our þndings support the use of cemented hemiarthroplasty for displaced intracapsular femoral neck fractures in the elderly

The optimal method of fixation for primary total hip replacements (THR), particularly fixation with or without the use of cement is still controversial. In a systematic review and meta-analysis of all randomized controlled trials (RCT) comparing cemented versus uncemented THRS available in the published literature, we found that there is no significant difference between cemented and uncemented THRs in terms implant survival as measured by the revision rate. Better short-term clinical outcome, particularly an improved pain score can be obtained with cemented fixation. However, the results are unclear for the long-term clinical and functional outcome between the two groups. No difference was evident in the mortality and the post operative complication rate. On the other hand, the Radiographic findings were variable and do not seem to correlate with clinical findings as differences in the surgical technique and prosthesis design might be associated with the incidence of osteolysis. We concluded in our review that Cemented THR is similar if not superior to uncemented THR, and provides better short term clinical outcomes. Further research, improved methodology and longer follow up are necessary to better define specific subgroups of patients in whom the relative benefits of cemented and uncemented implant fixation can be clearly demonstrated

Aims

Stemmed tibial components are frequently used in revision total knee arthroplasty (TKA). The purpose of this study was to evaluate patient satisfaction, overall pain, and diaphyseal tibial pain in patients who underwent revision TKA with cemented or uncemented stemmed tibial components.

Introduction. Severe osteolysis of the femur secondary to aseptic loosening in hip arthroplasty, remains a difficult revision scenario. Multiple techniques have been developed to aid the surgeon, including restoration of bone stock with impaction bone grafting or strut allografts, various distal fixation prostheses and mega-prostheses. Cemented femoral components, with integration of the cement into the cavitations, has largely fallen out of favour. We examined the long-term outcomes with this technique. Patients/Materials & Methods. Between 1977 and 1990, 109 patients had a cemented stem revision (without bone grafting) for severe femoral osteolysis in the absence of infection. Severe osteolysis was defined as cavitation in a minimum of 4 Gruen zones. Follow-up included functional scoring, radiological assessment and any complications. Further revision and survivorship analysis for stem failure or aseptic loosening of the femoral component were recorded. Results. 109 patients (117 hips) were reviewed with an average age of 65.4years (range 31–82). 39 patients had five zone involvement, 25 had six zone involvement and in 13 patients all seven zones were affected. 17 patients had an isolated stem revision, 100 patients had both components revised. Post-operative complications during the entire follow-up period were 7 dislocations, 10 trochanteric non-unions, 2 periprosthetic fractures and no infections. Only 9 patients had further revision of the femoral stem, 8 for aseptic loosening and 1 for stem fracture. In addition, re-revision procedures were performed for aseptic loosening of the cup (8 procedures) and dislocation (2 procedures). Analysis for stem revision demonstrated 91.17% survival at 12 years (minimum 40 hips at risk). Conclusion. Cemented revision arthroplasty for severe osteolysis of the femur has results comparable, if not superior, to alternative treatment modalities. Where restoration of bone stock is not a principle goal in the revision setting, cemented revision arthroplasty is a viable option in severe femoral osteolysis