To report the clinical, functional and radiological outcome of consecutive primary hip arthroplasties using large diameter (36mm and above) ceramic bearing couples. We believe this to be one of the first independent series.

We prospectively reviewed 519 consecutive primary THA using fully HAC coated acetabular shell and fully HAC coated stem (JRI Ltd) in 502 patients, with minimum follow-up of 32 months. A Biolox-Delta ceramic liner with an 18 deg taper and Biolox-Delta ceramic head (36mm and 40mm) were used in all cases, by 3 surgeons. None were lost to follow-up. Clinical outcome was measured using Harris, Charnley Oxford, EuroQol EQ-5D scores. Radiographs were systematically analysed for implant position, loosening, migration, osteolysis. Return to sports and hobbies were recorded.

Mean age was 64.9 yrs (11–82yrs). There were no dislocations. 50–62mm acetabular shells were used. 36 mm head was used in 92% of cases. No acetabular revisions were performed for aseptic loosening. Other re-operations were for infection (1), peri-prosthetic fractures (1). The mean Harris and Oxford scores were 95 (88–97) and 14.1 (12–33) respectively. Harris and Oxford scores were 95 (88–97) and 14.1 (12–33) respectively. The Charnley score was 5.7 (5–6) for pain, 5.8 (4–6) for movement and 5.9 (4–6) for mobility. There was a significant improvement in the range of movement of the hip. There was no migration of acetabular component. Acetabular radiolucencies were present around one shell. No acetabular liner wear was demonstrated in CT Scans. Mean inclination was 7.4deg(37–65). Mean EQ-5D description scores and health thermometer scores were 0.84 (0.71–0.92) and 88 (66–96). With an end point of definite or probable loosening, the probability of survival was 100%. Overall survival with removal or repeat revision of either component for any reason as the end point was 99.1%.

The results of this study show an excellent clinical and functional outcome and support the use of a fully coated prosthesis with ceramic bearing couples. We envisage monitoring and prospectively reporting the long-term outcome of this series of patients.

Aim: To assess the impact of three different entry points of the femoral canal preparation with regard to cement mantle thickness in the saggital plane.

Methods: We reviewed the literature to find that little has been written on the cement mantle thickness in the saggital plane. We reviewed randomly 60 total hip replacements performed at our institution to discover a common error of a thin cement mantle anteriorly (proximally) and posteriorly (distally) in the saggital plane.

We used standard saw-bone preparations of two prosthetic hip systems: Friendly (Lima) and Exeter (Stryker). In each hip system we performed five preparations for each entry point (trochanteric fossa, posterolateral corner and mid point of the cut neck). The only variable was the entry point. Preparation was performed according to the manufacturers’ recommendations. The preparations were x-rayed and cement mantle alignment and thickness were measured on the x-rays. Saggital sections with digital imaging and radial measurements were also performed.

Results: The results showed a strong trend towards neutral alignment (antero-posterior (AP) and saggital) and a uniform cement mantle with trochanteric fossa preparation. There was an increasing trend to varus alignment (AP), angled anterior to posterior alignment (saggital) and incomplete cement mantles with postero-lateral corner and mid point of cut neck preparation.

Conclusions: We conclude that in cemented femoral replacement, the entry point for canal preparation should be as far lateral and posterior as possible and the trochanteric fossa is the best to achieve neutral alignment and the complete cement mantle.