Aim: To compare the outcomes of cemented and uncemented primary total hip arthroplasty and to report the radiological features of 41 Exeter polished tapered stems which demonstrate good clinical scores at long-term review.

Methods: We set up a randomised trial, involving two surgeons, Twenty stems were modular and 21 were monoblock. The radiographic measurements, made using templates adjusted for magnification, included vertical subsidence of the stem, scoring of cement mantle thickness, analysis of the p-c and cement-bone (c-b) radiolucencies, and cement fracture in each of the Gruen zones on AP and lateral views.

Loosening was classified as possible if there was between 50 and 99 percent c-b radiolucency, probable when there was complete radiolucency, or definite when vertical subsidence was more than 5mm. The presence and type of radiological features analysed according to surgeon and whether a centraliser was utilised.

Results: There were no failures of the polished stems with 100% survival at 11 years. At the latest review, none of the polished cemented stems demonstrated definite or possible loosening. Osteolysis was found proximally in two cases and more distally in one case and each of these stems was implanted without a centraliser. Incomplete cement mantles and the presence of radiolucencies were more common around stems without centralisers, however the differences in results according to surgeon is a potential confounder and requires investigation in a larger series.

Conclusion: This study demonstrated excellent radiological results of the polished Exeter stem at mid to long-term follow-up.

There is a lack of properly undertaken comparative studies of total hip replacement (THR). A randomised trial was established to examine the hypothesis that there are no important differences in clinical outcome at 2 years and at long-term follow-up between cemented and uncemented primary THR in middle aged patients.Eighty-three patients with 90 osteoarthritic hips were randomised to a cemented Exeter THR involving a matte or polished tapered stem (n=47, median age 68yrs) or an uncemented PCA proximally porous-coated cobalt-chrome stem and porous coated press fit cup (n=43, median age 66yrs). Patients underwent immediate full weight bearing post-operatively. The follow-up period is 8 to 16 years. The median Harris hip scores for the cemented and uncemented groups respectively were 92 and 95 at 2 years and 89 and 96 at long-term follow-up. Four cemented hips have been revised for aseptic loosening. There have been no failures of the polished stems. An analysis of a larger series of matt versus polished cemented stems also found that the results of the polished stems were superior. Four uncemented hips have been revised, two more recently for acetabular wear and osteolysis. There was a high rate of radiographic demarcation of the cemented cups. There were no important differences in the clinical scores between cemented and uncemented THR. Some matte surfaced femoral stems failed and this trend was confirmed by analysis of a larger series. Osteolysis around the uncemented acetabular components is a concern. Importantly immediate weight bearing was associated with good results of uncemented stems.