Introduction: There have been concerns regarding early loosening of the Elite Plus implant. In addition, catastrophic failure has been reported with the Zirconia ceramic head in combination with Hylamer Ultra-High-Molecular-weight-polyethylene (UHMWPE) acetabular liner.

We reviewed all patients under the care of the senior author, who had undergone Elite Plus hip arthroplasty.

Methods: All patients are under regular review in a nurse-led clinic and complications recorded.

Pre and post-operative radiographs were assessed for adequacy of cementation and evidence of loosening.

Results: 197 patients (mean age 72 years) had undergone 225 Elite Plus total hip arthroplasties since 1996. An additional 21 patients had no radiographs or case notes available at the time of review – none of these are known to have failed.

Standard UHMWPE Ogee acetabular components were used in all cases. Thirty-six percent of heads were Zirconia. Mean survivorship of all implants 5 years 2 months.

The revision rate was 2.7%. Only one revision was performed for femoral component loosening.

At latest radiographic review all patients were asymptomatic. However, 31% of femoral components were possibly loose, 5% probably loose and none definitely loose using the Harris criteria. Thirty-four percent of acetabular components were possibly loose, 8% probably loose and 1% definitely loose using Charnley/DeLee criteria.

Discussion: Our results demonstrate satisfactory performance for this hip system. We have not found significant evidence of early failure with the Zirconia and Ogee combination.

A cement restrictor, high-viscosity cement and pressurisation were used as standard. Alternative cementation techniques may partially explain early failure seen in other series.