title: Impact of a learning curve on the survivorship of 4802 cementless total hip arthroplasties.
abstract: OBJECTIVE
  Our aim was to report survivorship data and lessons learned with the Corail/Pinnacle cementless total hip arthroplasty (THA) system.
  
  
  METHODS
  Between August 2005 and March 2015, a total of 4802 primary cementless Corail/Pinnacle THAs were performed in 4309 patients. In March 2016, we reviewed these hips from a prospectively maintained database.
  
  
  RESULTS
  A total of 80 hips (1.67%) have been revised which is equivalent to a cumulative risk of revision of 2.5% at ten years. The rate of revision was not significantly higher in patients aged ≥ 70 years (p = 0.93). The leading indications for revision were instability (n = 22, 0.46%), infection (n = 20, 0.42%), aseptic femoral loosening (n = 15, 0.31%) and femoral fracture (n = 6, 0.12%). There were changes in the surgical technique with respect to the Corail femoral component during the ten-year period involving a change to collared components and a trend towards larger size. These resulted in a decrease in the rate of iatrogenic femoral fracture and a decrease in the rate of aseptic loosening.
  
  
  CONCLUSIONS
  The rate of revision in this series is comparable with the best performing THAs in registry data. Most revisions were not directly related to the implants. Despite extensive previous experience with cemented femoral components, the senior author noted a learning curve requiring increased focus on primary stability. The number of revisions related to the femoral component is reducing. Any new technology has a learning curve that may be independent of surgical experience. Cite this article: Bone Joint J 2016;98-B:1589-96.
authors.affiliation: Musgrave Park Hospital, Belfast, Northern Ireland.
authors.forename: P
authors.initials: P
authors.lastname: Magill
authors.affiliation: Musgrave Park Hospital, Belfast, Northern Ireland.
authors.forename: J
authors.initials: J
authors.lastname: Blaney
authors.affiliation: Musgrave Park Hospital, Belfast, Northern Ireland.
authors.forename: J C
authors.initials: JC
authors.lastname: Hill
authors.affiliation: Centre Orthopedique Santy, Lyon, France.
authors.forename: M P
authors.initials: MP
authors.lastname: Bonnin
authors.affiliation: Musgrave Park Hospital, Belfast, Northern Ireland.
authors.forename: D E
authors.initials: DE
authors.lastname: Beverland
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000193:education / Q000379:methods / Q000592:standards*; D001843:Bone Cements; D016208:Databases, Factual; D004502:Education, Medical, Continuing; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects; D006801:Humans; D007593:Joint Instability / Q000601:surgery; D053208:Kaplan-Meier Estimate; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D057068:Periprosthetic Fractures / Q000601:surgery; D011474:Prosthesis Design; D011475:Prosthesis Failure / Q000209:etiology*; D016459:Prosthesis-Related Infections / Q000601:surgery; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D001843:Bone Cements
keywords: Cementless; Corail; Hip; Pinnacle; Revision; Uncemented