We have prospectively followed up 191 consecutive primary total hip replacements utilising a collarless polished tapered (CPT) femoral stem, implanted in 175 patients between November 1992 and November 1995.

At a mean follow-up of 15.9 years (range 14 – 17.5) 86 patients (95 hips) were still alive (25 men and 61 women) and available for routine follow up. Clinical outcome was determined from a combination of the Harris (HHS) and Oxford (OHS) hip scores. Radiological assessment was with antero-posterior radiographs of both hips and a lateral radiograph of the operated hip. The radiographs were evaluated using well-recognised assessment techniques.

There was no loss to follow up, with clinical data available on all 95 hips. Five patients were too frail to undergo radiographic assessment, therefore radiological assessment was performed on 90 hips (95%). At the latest follow-up, the mean HHS was 78 (range 28 – 100) and the mean OHS was 36 (range 15 – 48). Stems subsided within the cement mantle, with a mean total subsidence of 2.1mm (range 0.4 – 24). Higher grades of heterotopic bone formation were significantly associated with males (p<0.001) and hypertrophic osteoarthritis (p<0.001). Acetabular wear was associated with increased weight (p<0.001) and male sex (p=0.005). Amongst the cohort, only 1 stem (1.1%) has been revised due to aseptic loosening. This patient required reaming of their canal prior to implantation, as a result of a previous femoral osteotomy. The rate of stem revision for any cause was 7.4% (7 stems), of which 4.2% (4 stems) resulted from infection following revision of the acetabular component. Twenty patients (21.1%) required some sort of revision procedure; all except 3 of these resulted from failure of the acetabular component. Cemented cups had a significantly lower revision burden (2.7%) than Harris Galante uncemented components (21.8%) (p<0.001).

The CPT stem continues to provide excellent radiological and clinical outcomes at 15 years following implantation. Its results are consistent with other polished tapered stem designs. Cup failure remains a problem and is related in part to inadequate bearings and biological abnormalities.

Optimal utilisation of operating theatres has a significant impact on the ability of an institution to deliver productive, value for money surgical services. With the recent introduction of the national ‘Productive Theatres’ programme and in the current economic climate it is receiving increasing attention. In addition, it improves patient satisfaction and outcomes, reduces adverse events and has positive influences on staff morale. The aim of this study was to highlight factors influencing trauma theatre utilisation in general, whilst also addressing any problems identified with a view to improving trauma services locally. We conducted a prospective analysis of activity in the trauma theatre at our institution over 1 month. Direct observation was performed by a single independent observer. In the absence of any published guidelines, all theatre lists were assessed against pre-determined standards for each component of the theatre pathway. Overall end utilisation (combined time utilised for anaesthesia and surgery) was found to be low at 65%. A number of factors were found to contribute to inefficiencies including delay in sending for patients (mean 42mins, range 0-105), prolonged patient transit times to theatre (mean 22% of all sessions), late starts to lists (mean 43 mins, range 15-105 mins) waiting for x-ray availability (mean 21mins, range 10-45) and knock on delay from previous lists. Surgeons and anaesthetists were found to be, overall, arriving on time or early for all lists. Strategies for maximising trauma theatre productivity are essential. This study has identified common issues, of potential benefit to numerous institutions when planning trauma services.

Introduction

The success of total hip replacement in the young has consistently been worse both radiologically and clinically when compared to the standard hip replacement population.

We reviewed 142 consecutive primary hip arthroplasties using the Exeter Universal femoral stem implanted between 1988 and 1993 into 123 patients. 74 patients with 88 hips survived to 10 years or more and were reviewed with a mean 12 years 8 months. There was no loss to follow-up and the fate of all stems is known.

Our stem revision rate for aseptic loosening and osteolysis was 1.1% (1 stem); stem revision for any cause was 2.2% (2 stems); and re-operation for any cause was 21.6% (19 hips), all but 2 of which were due to cup failure.

All but one stem subsided within the cement mantle to an average of 1.5mm at final follow-up (0 to 8mm). One stem was revised for deep infection and one was revised for excessive periarticular osteolysis. One further stem had subsided excessively (8mm) and demonstrated lucent lines at the stem-cement and cement-bone interfaces. This was classified as a radiological failure and is awaiting revision. 28% of stems had cement mantle defects, which were associated with increased subsidence (p=0.01), but were not associated with endosteal lysis or stem failure.

Periarticular osteolysis was significantly related with the degree of polyethylene wear (p<0.001), which was in turn associated with younger age patients (p=0.01) and males (p<0.001).

The Exeter metal backed cups were a catastrophic failure with 34% revised (11 cups) for loosening. The Harris Galante cups failed with excessive wear and osteolysis, with failure to revision of 18%. Only 1 cemented Elite cup was revised for loosening and osteolysis (4%).

The Exeter Universal stem implanted outside the originator centre has excellent medium term results.