We performed 83 consecutive cemented revision total hip arthroplasties in 77 patients between 1977 and 1983 using improved cementing techniques. One patient (two hips) was lost to follow-up. The remaining 76 patients (81 hips) had an average age at revision of 63.7 years (23 to 89).

At the final follow-up 18 hips (22%) had had a reoperation, two (2.5%) for sepsis, three (4%) for dislocation and 13 (16%) for aseptic loosening. The incidence of rerevision for aseptic femoral loosening was 5.4% and for aseptic acetabular loosening 16%. These results confirm that cemented femoral revision is a durable option in revision hip surgery when improved cementing techniques are used, but that cemented acetabular revision is unsatisfactory.

The ‘cement reaction’ is a recognised cardio-respiratory response to methylmethacrylate bone cement, characterised by hypotension, reduced cardiac output, and on occasion fatal circulatory collapse. It is seen in 0.5-1% of cemented hip arthroplasties during the insertion and pressurisation of cement into the femur, and is believed to be secondary to marrow thromboembolism, the vasodilatory effect of methylmethacrylate, or a combination of the two. A number of steps, within the operating surgeon's control, can be undertaken to reduce the risk of the ‘cement reaction’ occurring.

An e-mail based questionnaire was sent to all trainees and consultants in the West of Scotland containing eight questions relating to cementing technique when performing hemiarthroplasty of the hip. The questions related to measures to reduce the potential for ‘cement reaction’, e.g.: whether or not they routinely use a cement restrictor.

Seventy-two complete replies were received. For five of the eight measures, the surgeons routinely employed the suggested practices. For the remaining three, the consensus opinion was contrary to the suggested practice for reduction of the risk of ‘cement reaction’. These were with respect to the surgical approach employed, whether or not to attempt to remove all cancellous bone from the proximal femur, and the use, or not, of a venting tube during cement insertion. In all three cases, the difference was statistically significant on chi-squared testing.

The cohort of surgeons questioned routinely employ more than half of the methods suggested to reduce the potential for ‘cement reaction’ in hemiarthroplasty of the hip. Further surveys of why they do, or do not, undertake certain practices during cementing would help improve awareness of ‘cement reaction’, and perhaps reduce the incidence of this potentially fatal phenomenon.

The Exeter Trauma Stem (ETS) is a monoblock unipolar prosthesis currently in use throughout various orthopaedic departments. It can be a useful procedure for specialty trainees in developing modern cementation techniques in hip arthroplasty. We propose that in order for this procedure to be a valid training tool that, as well as having a standardized surgical approach and operative technique, outcomes should be easily assessed and should be similar if performed by either a trainee or consultant. All ETS procedures carried out at our institution from January 2009 until September 2011 were reviewed retrospectively. Patient demographics and operative details were recorded from patient notes. Radiographic evaluation involved the Barrack cementation grading system, Dorr's criteria, stem alignment and leg length measurement. There was no significant difference in operative time between ETS performed by consultant or by specialty trainee. On postoperative x-ray, cement mantles were Barrack grade A or B in 55.6% (trainees) versus 61.9% (consultants). Stem alignment was neutral in 50% and varus in 50% of cases for trainees, versus 28.6% and 71.4% of cases for consultants. In total, 69.2 % of patients had lengthening of the operated limb with a mean increase of 10.4mm (2–25) for trainees and 9.3mm (2–18) for consultants. Both trainees and consultants can attain a good cement mantle. However, from our results stem alignment is less accurate by trainees with half being placed in varus. Our results highlight the difficulty of obtaining correct leg length positioning with the ETS with trainees and consultants having similar discrepancies. The ETS is a useful procedure for orthopaedic trainees to attain adequate skills in modern cementation techniques with similar post-operative radiographic outcomes to consultants. The tendency for trainees to be less accurate with stem positioning could be improved with supervision or careful pre-operative templating