One hundred and ninety six unselected patients who had 200 consecutive primary total hip replacements between January 1994 and May 1995 using the Elite Plus cemented femoral component (DePuy International Leeds UK) were enrolled in a prospective outcome study. 155 patients (159 hips) were followed up for a minimum of 4.5 years (mean 5.4, range 4.5 to 6.9).Twenty four patients (24 hips −12%) died and 15 patients (15 hips) were lost to follow up. Two hips had been revised prior to the 5 year follow up. The average age was 68.4 years (range 35 to 94) at the time of the index arthroplasty. The patients were evaluated clinically using the Harris Hip Score and also radiologically. A self administered Oxford Hip Questionnaire was also used. A Kaplan-Meier survivorship analysis was performed with revision as the end point.

The mean Harris Hip Score was raised from 39.3 pre-operatively to 89.6 at five years. The mean Oxford Hip Score was 23. There were no revisions for aseptic loosening.

Radiographic review at 5 years showed mean femoral subsidence was 1.4mms with an average of 0.28mms per year. The cumulative survivorship at 5 years was 98.7% and the mean annual rate of re-operation was 0.2%.

In the present series, the Elite Plus hip arthroplasty has produced clinical and radiological results which would justify its position as a modern progression of the Charnley with comparable results at five years.

Femoral Impaction allografting is now an established method in revision hip arthroplasty where there is a deficiency in bone stock. Most experience of this technique has been in conjunction with a cemented collarless, polished, tapered (CPT) stem. We conducted a retrospective study into the clinical and radiological results of 67 consecutive patients with an average of 62 months (36–108 months) follow-up. In all cases, Impaction bone grafting was performed using a transtrochanteric approach and cemented Charnley and Elite Plus stems.

In our series no femoral component has been revised. The overall subsidence was 2.2 mm. 57 hips (85%) showed subsidence of 4 mm or less. However two patients showed massive subsidence of greater than 10mm, both with associated osteolysis and radiolucent lines. In addition, one stem showed a progressive varus position and debonding of the cement-metal interface. Analysis of the bone allograft showed evidence of incorporation in 56 (84%) of patients. The Merle D’Aubigne-Postal clinical score increased from an average of 8.3 pre-operatively to 15.3 at the last review. 60 patients (89.5%) complained of no or slight pain.

There was a 10% re-operation rate due to complications. Three patients sustained periprosthetic fractures around the tip of the prosthesis, all successfully treated with a plate. Three patients suffered recurrent dislocation, two needed revision of the acetabula component. Two patients needed trochanteric wires removed for persistent pain.

Direct comparison of different prostheses is difficult due to many confounding variables. However the medium term results of our study are comparable to the results reported using the Exeter and CPT stems.