We reviewed 158 hip replacements performed using the Exeter® stem between 1992 and 1996. The operations were performed using third generation cementation and the majority using medium viscosity Simplex cement via a posterior approach. Per-operative complications [shaft fracture etc] were not seen.

Using stem revision as an endpoint, only one stem has been revised [0.6%] for aseptic loosening, and one for sepsis. Aseptic asymptomatic loosening was observed in a further 4 patients [2.5%]. Stem subsidence was seen in the majority [81%], but none greater than 3mm [mean 1.4mm]. Other complications were rare.

This medium term review confirms that the Exeter® stem is a prosthesis with excellent results. This is one of the first series published outside Exeter to confirm their reported results.

To discover the long-term outcome of internal fixation for displaced fractures of the distal adult humerus, we have re-assessed a cohort of 57 patients studied 10 years ago. Forty patients (70%) were identified, 13 had died, leaving 27 adult patients at an average of 17 years after operation (14–20 years).

Eighteen were Müller type C, (five open), eight type B and two type A. All were treated with stable internal fixation. Early active mobilisation was mandatory. The majority were approached using a chevron olecranon osteotomy. The patients were assessed radiographically and using a modification of the Mayo Clinic Performance Index for the Elbow. The patients were also asked about their perception of the outcome of surgery, and overall satisfaction. Based upon the Mayo Score, 33% had an excellent result, 63% good and four percent fair. None had a poor outcome.

Pain was generally only mild if present at all, with only three stating that it interfered with hobbies or work. Only one required regular use of analgesics. Sensory abnormalities were found in eight patients, four in the ulnar distribution, one median, two whole hand and one whole arm. None considered this unpleasant or a problem. Discomfort attributed to the metalwork was found in four patients, six have had some or all removed. All but one was able to attend to all activities of daily living without problems. Patient satisfaction was excellent or good in 83% and satisfactory in 17%.

This study is the first to demonstrate that early stable internal fixation of distal humeral fractures by an experienced surgeon, gives excellent long term results with few complications, together with high rates of patient satisfaction and little functional morbidity.