Dual mobility (DM) is an established bearing option in Total Hip Arthroplasty (THA). The traditional mono-block DM designs have limited ability for additional fixation, whereas the modular DM designs allow additional screw fixation but limit internal diameter and have the potential to generate metal debris. We report the early results of a CoCrMo alloy mono-block implant manufactured by additive technology with a highly porous ingrowth surface to enhance primary fixation and osseointegration. Prospective follow-up of the Duplex. TM. implant first inserted in March 2016 enrolled into Beyond Compliance (BC). Primary outcome measure was all-cause revision and secondary outcomes dislocation, peri-prosthetic fracture (PPF) and Oxford Hip Score (OHS). Patients were risk stratified and all considered to be high risk for instability. Complications were identified via hospital records, clinical coding linkage using national database and via BC website. 159 implants in 154 patients with a mean age 74.0 years and a maximum F/U of 7 years. Survivorship for all-cause revision 99.4% (95% CI 96.2–99.8). One femoral only revision. Mean gain in OHS 27.4. Dislocation rate 0.6% with a single event. Patients with a cemented Polished taper stem (PTS) had a Type B PPF rate of 2.1% requiring revision/fixation. Compared to conventional THA this cohort was significantly older (74.0 vs 68.3 years), more co-morbidity (ASA 3 46.5% vs 14.4%) and more non-OA indications (32.4% vs 8.5%). Every patient had at least one risk factor for falling and >50% of cohort had 4 or more risk factors using NICE tool. We believe our results demonstrate that risk stratification successfully aids implant selection to prevent dislocation in high-risk patients. This novel design has provided excellent early results in a challenging cohort where individuals are very different to the “average” THA patient. NJR data on DM has reported an increase in revision for PPF. A “perfect storm” maybe created using DM in high-risk falls risk population. This re-enforces the need to consider all patient and implant factors when deciding bearing selection

Cement is the commonest method used to fix femoral components in the UK. This is not surprising as in the UK cemented fixation has provided better results than cementless fixation. The results of cemented fixation do however depend on the design of the stem. Polished collarless tapered stems are now the most widely used stems in the UK. These stems subside within the cement mantle thus compressing the cement and cement-bone interface and preventing these from failing. They are thus very tolerant of poor quality cementing. As a result aseptic loosening is extraordinarily rare even in young active patients. Compared with cementless fixation cement is very forgiving. It can be used with ease whatever the anatomy of the proximal femur and whatever the bone quality. Correct leg length can also easily be achieved. Thigh pain does not occur and intra-operative fractures are very rare. The antibiotics in the cement decrease the incidence of infection. In addition cement provides an effective barrier to particulate debris and joint fluid under pressure. The only real disadvantage of cemented fixation is that it may take longer than cementless fixation. However this extra time spent is compensated by the cheaper implant costs