Introduction & Aims: To study the survivorship and subsidence patterns of the first 433 Exeter polished, totally collarless, double tapered, cemented stems that were inserted between November of 1970 and the end of 1975 by 16 different surgeons (13 of them in the training grades) utilising first generation cementing techniques. Method: A survivorship study up to the 33rd year of follow-up, using the Kaplan Meier method, was performed for all 433 hips, the end-point being revision for aseptic stem loosening. Stem subsidence in relation to the cement and the bone was measured in all survivors by a single observer on digitised films (magnified 200%) using the OrthochartTM software. Stem subsidence, the grade of cementing, ‘calcar’ resorption, visible cement fractures, focal lysis and radiolucent lines at the interfaces were assessed. Results: Of the 433 hips, 21 were revisions of previously failed hips. 21.7% patients have had a re-operation, including 3.7% for stem fracture, 3.5% for neck fracture (all from a group of 95 stems with excessively machined necks), 8.5% for aseptic cup loosening, 3.5% for aseptic stem loosening, 1.8% for infection and 0.5% for recurrent dislocation). For the overall series, with revision for aseptic stem loosening as the end-point, the survivorship is 93.5% (95%CL: 90.0% to 97.0%). When all cases lost to follow-up (28 hips) are regarded as failures, survivorship is 85.8% (95% CI of 81.3 to 90.3%). The average age at operation of the survivors was 55.7years. No significant radiological subsidence between the cement and bone was found. Mean subsidence between the stem and cement was 2.15mm, most occurring in the first 5 years and in all but 1 being less than 4. The maximum was 18mm (grade D cementing). Cementing grades were: B-65%, C-27%, D-8%. Resorption of the neck (13%) was associated with excessive socket wear or cement left over the cut surface of the neck (the ‘pseudocollar’). Visible cement fractures were found in 14%, none associated with focal lysis, which was seen in 11%. Conclusions: Although 21.7% of patients in this series of the first 433 Exeter hips to be inserted in Exeter needed a re-operation of some sort, the stem rarely required surgery for aseptic loosening and was associated with benign long-term x-ray appearances in spite of 1st generation cementing
