Single-surgeon retrospective cohort of 330 cemented Charnley THAs performed 1970–1972, followed for a minimum of 20 years. The study establishes long-term durability benchmarks for first-generation cemented hip replacement — the first reported series with a minimum 20-year follow-up. The central question: does the cup or the stem fail first, and who is at risk?
The burning question in 1993 was whether first-generation cemented THA would hold up past a decade — and whether the cup or stem would define the failure curve. This paper answered both definitively, with the longest minimum follow-up reported at the time.
The femoral stem is not the problem. Kaplan-Meier survivorship free from femoral loosening revision was 95% at 20 years. The cemented acetabular component is the problem, with 23% combined loosening in survivors and only 43% survivorship when radiographic loosening is the endpoint. This asymmetry is the direct historical rationale for cementless acetabular fixation while retaining cemented femoral stems.
When counseling a young patient about THA longevity, cite this paper: male sex, age under 50, and high activity level each independently and significantly raised revision risk, with young age carrying the strongest signal (p=0.0005). This is why we hesitate before implanting a cemented cup in a 45-year-old active patient.
The acetabular loosening curve did not plateau after 10 years. It kept climbing, and the first cup revision did not occur until 9.5 years. Do not be reassured by good 5- or 10-year cup data on any fixation system; this lesson applies equally to modern cementless designs.
Single-surgeon retrospective cohort of 330 cemented Charnley THAs performed 1970–1972, followed for a minimum of 20 years. The study establishes long-term durability benchmarks for first-generation cemented hip replacement — the first reported series with a minimum 20-year follow-up. The central question: does the cup or the stem fail first, and who is at risk?
The burning question in 1993 was whether first-generation cemented THA would hold up past a decade — and whether the cup or stem would define the failure curve. This paper answered both definitively, with the longest minimum follow-up reported at the time.
The femoral stem is not the problem. Kaplan-Meier survivorship free from femoral loosening revision was 95% at 20 years. The cemented acetabular component is the problem, with 23% combined loosening in survivors and only 43% survivorship when radiographic loosening is the endpoint. This asymmetry is the direct historical rationale for cementless acetabular fixation while retaining cemented femoral stems.
When counseling a young patient about THA longevity, cite this paper: male sex, age under 50, and high activity level each independently and significantly raised revision risk, with young age carrying the strongest signal (p=0.0005). This is why we hesitate before implanting a cemented cup in a 45-year-old active patient.
The acetabular loosening curve did not plateau after 10 years. It kept climbing, and the first cup revision did not occur until 9.5 years. Do not be reassured by good 5- or 10-year cup data on any fixation system; this lesson applies equally to modern cementless designs.