Revision hip surgery is reportedly rising inexorably yet not all units report this phenomenon. The outcome of 1143 consecutive Corin TaperFit primary hip arthroplasties (957 patients) performed between 1995 and 2010 is presented. The implants were cemented under pressurisation and combined the TaperFit stem with Ogee flanged cups.

Data was gathered from local arthroplasty database and case note review of revised joints. 13 hips have been revised (1.1%). Cumulative prosthesis survival is 0.99 +/− 0.0. Two femoral stems were revised (0.2%); one at 6 months for sepsis, one at 14 days after dislodgment during reduction of dislocation. No revisions were undertaken for aseptic loosening of the stem or cup, nor for thigh pain. 32 patients (32 hips) ≥15 year follow up, 13 survive today and none have been revised (0%). Of the 471 with ≥10 year follow up, 38 were aged ≤50 at time of surgery and 1/38 has been revised to date (PLAD for dislocation).

The strong population stability in this region, supported by independent investigation by Scottish Arthroplasty Project, endorses the accuracy of the data quoted. The low incidence of revision in this cohort, and absence of revision for aseptic loosening (mean follow up 8.03 years +/− SD 3.94; range 18 months to 16yrs 2 months), substantially supports the longevity and use of cemented, double-taper, polished, collarless femoral stems in combination with cemented polyethylene cups in primary hip arthroplasty in all patient age groups.

We investigated the relationship between a number of patient and management variables and mortality after surgery for fracture of the hip. Data relating to 18 817 patients were obtained from the Scottish Hip Fracture Audit database. We divided variables into two categories, depending on whether they were case-mix (age; gender; fracture type; pre-fracture residence; pre-fracture mobility and ASA scores) or management variables (time from fracture to surgery; time from admission to surgery; grade of surgical and anaesthetic staff undertaking the procedure and anaesthetic technique).

Multivariate logistic regression analysis showed that all case-mix variables were strongly associated with post-operative mortality, even when controlling for the effects of the remaining variables. Inclusion of the management variables into the case-mix base regression model provided no significant improvement to the model. Patient case-mix variables have the most significant effect on post-operative mortality and unfortunately such variables cannot be modified by pre-operative medical interventions.

The long term survival of well-cemented, polished tapered stems is now proven. In spite of this, doubts remain about the phenomenon of subsidence which is essential to the mechanical integrity of these devices yet anathema to those surgeons who favour collared stems. Believing that the quality of cementing is more important than stem geometry, this study looked at the subsidence of 880 polished tapered stems [Corin, Taperfit} all implanted through an antero-lateral approach with a consistent cementing technique. In addition, for this implant, a new stem introducer was used to ensure accurate placement within the cement mantle.

Four sizes of stem were available and were used in the following numbers: size 1 [345], size 2 [381], size 3 [117] and size 4 [37]. Most subsidence occurs in the first year after surgery. These patients were all assessed with a minimum of one year. There was no difference in the rates of subsidence between these stem sizes. There were 14 revisions. Ten were for aseptic cup loosening and 4 for infection. There were no stem failures due to loosening.

Although all manufacturers producing such stems market a variety of sizes none emphasise that the stem geometry varies considerably from the smallest to the largest. Indeed, the variation within individual ranges is greater than the variation between sizes from different manufacturers.

The results obtained strongly support the thesis that it is the interaction between the cement and the stem which is important and that with a tapered polished stem the quality of cement technique is the least forgiving part of the operation