We determined the ten-year life expectancy of 5831 patients who had undergone 6653 elective primary total hip replacements at a regional orthopaedic centre between April 1993 and October 2004. Using hospital, general practitioner and the local health authority records, we recorded the dates of death for those who died following surgery. The mean age at operation was 67 years (13 to 96) with a male:female ratio of 2:3. Of 1154 patients with a ten-year follow-up 340 (29.5%) had died a mean of 5.6 years (0 to 10) after surgery. Using Kaplan-Meier curves, the ten-year survival was 89% in patients under 65 years at surgery, 75% in patients aged between 65 and 74 years, and 51% in patients over 75. The standardised mortality rates were considerably higher for patients under 45 years, 20% higher for those between 45 and 64 years, and steadily reduced in patients aged 65 and over. The survival of cemented hip replacement derived from the Swedish Hip Arthroplasty Register Annual Report 2004 exceeds the life expectancy of patients over the age of 60 in our area, suggesting that cemented hip replacement is the procedure of choice in this population.

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Anterior cortical penetration of distal femora when using long gamma nails is well established. To avoid this complication, using the appropriate entry point, a nail with a smaller radius of curvature, and intraoperative imaging is suggested. Despite this, there are times when the guidewire or the nail can abut or even perforate the anterior cortex. This is more likely to occur in patients with scalloped anterior distal femora and increased femoral anterior bowing. The authors overcome this potential problem during surgery by using a bent-tip guidewire. Their technique is cost neutral, safe, and quick. [ Orthopedics . 2019; 42(1):e135–e137.]