To establish whether postoperative x-rays were of sufficient quality compared to those at the first outpatients’ appointment, uncomplicated primary total knee replacements performed by one surgeon were reviewed retrospectively. Measurements were made from these X-rays. Rotation was also assessed.

Forty-eight knee replacements were reviewed. Postoperative films showed the tibial tray to be tilted an average of 5. 04 degrees and a femoral valgus angle of 1. 56 degrees. First outpatients’ X-rays showed the tibial tray to be tilted an average of 1. 16 degrees and the femoral valgus angle to be an average 5. 16 degrees. 15 of 25 postoperative films were found to be rotated compared to 1 of 25 in the outpatients’ group.

Immediate postoperative films are of variable and often poor quality. Films at the first outpatients’ appointment were of superior quality.

We reviewed a consecutive series of 241 uncemented, porous-coated anatomic (PCA) hip replacements at an average follow-up of five years (2 to 9). Of these, 32 had failed (13%), 26 at the acetabular component (11%) and six at the femoral component (2%). Acetabular failure was associated with local osteolysis and excessive polyethylene wear in 20 cases: in these histological examination showed giant macrophages incorporating numerous particles of high-density polyethylene. The femoral failures were related to a poor intramedullary fit with subsequent subsidence. Using the recommendation for revision as the end point, the cumulative survival rate for prostheses was 91% at six years (95% CI +/- 6%), 73% (+/- 11%) at seven years, and 57% (+/- 20%) at eight years. The result of uncemented PCA hip replacement is satisfactory up to six years, but then increasing failure of the acetabular component appears to be due to polyethylene wear, leading to osteolysis, loosening and component migration. At first, failure is often asymptomatic; routine follow-up of uncemented hip replacement is essential, especially after five years.