Prostheses used in hip and knee replacement procedures, 2008

Transcription

1 Prostheses used in hip knee replacement, National Joint Registry for Engl Wales 6 th Annual Report

2 Contents 1 Prostheses used in hip, Femoral head material size Br sales of conventional total hips resurfacing prostheses Combinations of cups stems Summary Prostheses used in knee, Prostheses entered into the NJR Usage of fixed versus mobile bearing tibial inserts Cement use 70 4 Bone substitute use 72 Tables Table 1 Frequency of material chosen for femoral heads in performed in Table 2 Frequency of femoral head sizes for performed in Table 3(a) Cemented cup brs entered into the NJR during 2008 for primary hip replacements Table 3(b) Cemented cup brs entered into the NJR during 2008 for revision hip replacements Table 4(a) Cementless cup brs entered into the NJR during 2008 for primary hip Table 4(b) Cementless cup brs entered into the NJR during 2008 for revision hip Table 5(a) Cemented stem brs entered into the NJR during 2008 for primary hip Table 5(b) Cemented stem brs entered into the NJR during 2008 for revision hip Table 6(a) Cementless stem brs entered into the NJR during 2008 for primary hip replacements Table 6(b) Cementless stem brs entered into the NJR during 2008 for revision hip replacements Table 7 Brs of resurfacing heads entered into the NJR in Table 8 Procedures using a resurfacing cup with conventional stem in Table 9(a) Cup-stem combinations in the NJR in 2008 for hip primary Table 9(b) Cup-stem combinations in the NJR in 2008 for hip revision where both were implanted during the revision Table 10(a) Total condylar knee brs entered into the NJR in 2008 for primary total knee replacements Table 10(b) Total condylar knee brs entered into the NJR in 2008 for revision knee replacements Table 11 Total condylar knee brs entered into the NJR in 2008 for unicondylar knee replacements Table 12 Patello-femoral joint brs entered into the NJR in Table 13 Fixed rotating hinged knee brs, Table 14 Tibial insert type Table 15 Type of cement used in hip knee replacement entered into the NJR in Table 16 Brs of antibiotic bone cement entered into the NJR in Table 17 Brs of non-antibiotic bone cement entered into the NJR in Table 18 Brs of synthetic bone substitute entered into the NJR in National Joint Registry

3 National Joint Registry for Engl Wales 6 th Annual Report 1 Prostheses used in hip, Femoral head material size Table 1 shows the relative usage of different femoral heads. There has been a 2 decrease in the use of metallic heads a 3 increase in the use of alumina heads compared with Table 1 Frequency of material chosen for femoral heads in performed in Material Number of Percentage 56,968 metallic 41, alumina 15, zircon Br sales of conventional total hips resurfacing prostheses Tables 3 to 8 show the most frequently used brs in Engl Wales during 2008, as assessed by their rate of entry into the NJR. The level of assessment according to Orthopaedic Data Evaluation Panel (ODEP) criteria is given in the final column. Tables 3 to 6 have been split into two to show br usage in primary revision. Table 2 shows the frequency of the different femoral head sizes. The main change compared with 2007 is a 6 increase in the use of heads classified as other size (these are generally 36mm heads) a 3 increase in the use of 32mm heads for metal on metal articulations. Less than 1 of other sized heads were implanted with a resurfacing cup. It is planned that a further size category (36mm) is added to the National Joint Registry (NJR) component classification in order to underst the change in head size practice. Table 2 Frequency of femoral head sizes for performed in Head size Number of Percentage 57, , , , , other 12, National Joint Registry 3

4 Table 3(a) Cemented cup brs entered into the NJR during 2008 for primary hip replacements. Manufacturer Br Total components Percentage ODEP rating 23,925 CONTEMPORARY 7, A ELITE PLUS OGEE 3, A ELITE PLUS CEMENTED 2, A EXETER DURATION 1, A OPERA 1, B CHARNLEY CEMENTED 1, A CHARNLEY OGEE 1, A ZCA 1, A LOW PROFILE MULLER unclassified STANMORE-ARCOM A Corin CENATOR CEMENTED A ULTIMA CEMENTED A FURLONG CEMENTED B WROBLEWSKI GOLF BALL B M2A CEMENTED B ARCOM SHP A APOLLO pre-entry ZIMMER CEMENTED A Mathys Orthopaedics CCB MATHYS A SP unclassified MARATHON pre-entry REFLECTION CEMENTED 96 <1 10A Waldemar Link INTERPLANTA 77 <1 10A METASUL-WEBER 76 <1 3A PE-PLUS 65 <1 10C Ortho-ID POLAR CEMENTED 59 <1 unclassified CMK CEMENTED 58 <1 unclassified CENTERPULSE MULLER 57 <1 unclassified Waldemar Link LINK FLANGE 44 <1 unclassified Finsbury SLF CEMENTED (FINSBURY) 43 <1 10C Implants International EDINBURGH 35 <1 unclassified 4 National Joint Registry

5 National Joint Registry for Engl Wales 6 th Annual Report Manufacturer Br Total components Percentage ODEP rating ODC 32 <1 unclassified Corin HI-NEK CEMENTED 31 <1 unclassified Waldemar Link SNAP FIT 29 <1 unclassified B Braun/Aesculap CHIRULEN 27 <1 unclassified Implants International CCB 22 <1 unclassified WROBLEWSKI ANGLE BORE 21 <1 7B SOCKET METASUL-MULLER 16 <1 unclassified SPC 11 <1 unclassified B Braun/Aesculap ALFA CEMENTED 5 <1 unclassified ELITE PLUS FLANGED 2 <1 10A HYLAMER 2 <1 unacceptable Symbios SA PE 2 <1 unclassified BIOMET MULLER 1 <1 5B CUSTOM HC 1 <1 not applicable SCAN CEMENTED 1 <1 unclassified HYLAMER OGEE 1 <1 unacceptable Orthodynamics ORTHODYNAMICS 1 <1 7B Sovereign Medical BICANA 1 <1 unclassified ARDEN 1 <1 unclassified National Joint Registry 5

6 Table 3(b) Cemented cup brs entered into the NJR during 2008 for revision hip replacements. Manufacturer Br Total components 1,378 CONTEMPORARY ELITE PLUS OGEE ELITE PLUS CEMENTED OPERA 91 7 CHARNLEY CEMENTED 70 5 EXETER DURATION 70 5 CHARNLEY OGEE 48 3 FURLONG CEMENTED 36 3 ULTIMA CEMENTED 35 3 ZCA 32 2 WROBLEWSKI GOLF BALL 28 2 LOW PROFILE MULLER 26 2 SP STANMORE-ARCOM 21 2 Corin CENATOR CEMENTED 21 2 MARATHON 18 1 ZIMMER CEMENTED 16 1 APOLLO 11 1 Waldemar Link SNAP FIT 11 1 ODC 10 1 B Braun/Aesculap CHIRULEN 8 1 ARCOM SHP 8 1 REFLECTION CEMENTED 8 1 WROBLEWSKI ANGLE BORE SOCKET 4 <1 Ortho-ID POLAR CEMENTED 4 <1 Waldemar Link INTERPLANTA 4 <1 HI-WALL 3 <1 SOLUTION CEMENTED 3 <1 Mathys Orthopaedics CCB MATHYS 3 <1 BIOMET BI-POLAR CEMENTED 2 <1 Corin HI-NEK CEMENTED 2 <1 Finsbury SLF CEMENTED (FINSBURY) 2 <1 Implants International EDINBURGH 2 <1 CMK CEMENTED 1 <1 M2A CEMENTED 1 <1 CENTERPULSE MULLER 1 <1 METASUL-MULLER 1 <1 6 National Joint Registry

7 National Joint Registry for Engl Wales 6 th Annual Report Table 4(a) Cementless cup brs entered into the NJR during 2008 for primary hip. Manufacturer Br Total components ODEP rating 31,377 PINNACLE 10, A TRIDENT 6, A TRILOGY 3, A CSF 2, A CSF PLUS 1,339 4 unclassified EPF-PLUS 1, A EXCEED 1, A DURALOC A REFLECTION B ALLOFIT A TRABECULAR METAL pre-entry ABG II A B Braun/Aesculap PLASMA A FURLONG THREADED A Wright Medical UK PROCOTYL pre-entry DURALOC OPTION A POLAR unclassified MALLORY-HEAD 134 <1 5A BICON-PLUS 97 <1 3A Medacta UK VERSAFIT 83 <1 unclassified Wright Medical UK ANCAFIT 71 <1 3A SECURE FIT 70 <1 5A Surgicraft SPLIT 66 <1 unclassified Mathys Orthopaedics RM (MATHYS) 50 <1 10A Symbios SA APRIL 45 <1 unclassified Mathys Orthopaedics SELEXYS PC 37 <1 pre-entry Mathys Orthopaedics SELEXYS TH 35 <1 pre-entry CLS 31 <1 10A Wright Medical UK LINEAGE 25 <1 pre-entry TRITANIUM 23 <1 unclassified FITMORE 18 <1 7B National Joint Registry 7

8 Manufacturer Br Total components ODEP rating BIOMEX 17 <1 pre-entry Corin DC-FIT 15 <1 unclassified Waldemar Link MCMINN 15 <1 unclassified Amplitude SATURNE 14 <1 3B GAP2 14 <1 not applicable UNIVERSAL II 13 <1 5A GAP RING 11 <1 not applicable J-LOC 9 <1 unclassified Waldemar Link PROCOTYL 9 <1 unclassified Amplitude EQUATEUR 8 <1 3A Amplitude HORIZON 8 <1 3A Implants International RM (IMPLANTS 7 <1 unclassified INTERNATIONAL) Orthodynamics NOVAE SF 7 <1 10B BOFOR 5 <1 unclassified RANAWAT/BURSTEIN 4 <1 unclassified S-ROM 4 <1 not applicable PAR 5 RINOWL 3 <1 unclassified REGENEREX 3 <1 not applicable Mathys Orthopaedics SELEXYS 3 <1 pre-entry Waldemar Link PRESSFIT 3 <1 unclassified Orthodynamics NOVAE 2 <1 10B BIHAPRO 1 <1 7B RINGLOC 1 <1 unclassified CUSTOM 1 <1 not applicable Orthodynamics NOVAE STICK 1 <1 10B 8 National Joint Registry

9 National Joint Registry for Engl Wales 6 th Annual Report Table 4(b) Cementless cup brs entered into the NJR during 2008 for revision hip. Manufacturer Br Total components 3,542 TRIDENT PINNACLE TRILOGY TRABECULAR METAL CSF REFLECTION MALLORY-HEAD 82 2 SECURE FIT 61 2 DURALOC 49 1 Wright Medical UK PROCOTYL 46 1 Amplitude SATURNE 44 1 GAP B Braun/Aesculap PLASMA 35 1 POLAR 28 1 EXCEED 26 1 TRITANIUM 22 1 EPF-PLUS 20 1 CSF PLUS 19 1 ALLOFIT 17 <1 GAP RING 17 <1 S-ROM 15 <1 ABG II 14 <1 PAR 5 RINOWL 12 <1 BICON-PLUS 12 <1 FURLONG THREADED 12 <1 Waldemar Link MCMINN 8 <1 Orthodynamics NOVAE STICK 7 <1 Surgicraft SPLIT 7 <1 BOFOR 5 <1 Orthodynamics NOVAE 5 <1 RANAWAT/BURSTEIN 4 <1 Mathys Orthopaedics RM (MATHYS) 3 <1 National Joint Registry 9

10 Manufacturer Br Total components BIHAPRO 2 <1 BIOMEX 2 <1 CLS 2 <1 FITMORE 2 <1 Corin DC-FIT 2 <1 OCTOPUS 2 <1 Orthodynamics NOVAE COPTOS 2 <1 Orthodynamics NOVAE SF 2 <1 Wright Medical UK ANCAFIT 2 <1 Wright Medical UK LINEAGE 2 <1 ALIZE 1 <1 DURALOC OPTION 1 <1 FRF 1 <1 Orthodynamics CUSTOM 1 <1 Stanmore Implants Worldwide SIW 1 <1 Symbios SA APRIL 1 <1 10 National Joint Registry

11 National Joint Registry for Engl Wales 6 th Annual Report Table 5(a) Cemented stem brs entered into the NJR during 2008 for primary hip. Manufacturer Br Total components ODEP rating 31,703 EXETER V40 19, A CPT 2, A CHARNLEY CEMENTED 2, A C- CEMENTED 1, B C- AMT CEMENTED A STANMORE MODULAR A CPS-PLUS A MS B CPCS pre-entry MULLER STR A MULLER- BIOMET B FURLONG CEMENTED C CHARNLEY MODULAR A Waldemar Link SP II CEMENTED A Mathys Orthopaedics CCA CEMENTED 159 <1 10A Corin TAPERFIT CEMENTED 156 <1 7B P10 MULLER 139 <1 10A TAPERLOC CEMENTED 129 <1 pre-entry OMNIFIT CEMENTED 123 <1 10A SPECTRON 101 <1 10A VERSYS CEMENTED 94 <1 5A Finsbury ADEPT CEMENTED 77 <1 pre-entry OLYMPIA 68 <1 5B ELITE PLUS CEMENTED 63 <1 10A CMK CEMENTED 57 <1 10C CEMENTED 52 <1 not applicable B Braun/Aesculap CENTRAMENT 48 <1 unclassified Corin HI-NEK CEMENTED 39 <1 unclassified MONOBLOC STANMORE 38 <1 10A EXETER 36 <1 10A BIMETRIC CEMENTED 31 <1 10A Finsbury LIVERPOOL PROXIMAL CEMENTED 31 <1 not applicable Implants International EDINBURGH 27 <1 unclassified National Joint Registry 11

12 Manufacturer Br Total components ODEP rating THRUST PLATE 26 <1 unacceptable Wright Medical UK PROFEMUR CEMENTED 21 <1 pre-entry B Braun/Aesculap EXCIA-CEMENTED 19 <1 unclassified ULTIMA STRAIGHT 14 <1 10C ZMR CEMENTED 14 <1 not applicable SUMMIT CEMENTED 10 <1 pre-entry VERSYS HERITAGE 9 <1 pre-entry MALLORY-HEAD CEMENTED 8 <1 unclassified REVITAN CEMENTED 8 <1 not applicable MEM 7 <1 10A MAYO CEMENTED 7 <1 unclassified B Braun/Aesculap BICONTACT CEMENTED 6 <1 10C Corin TRIFIT CEMENTED 6 <1 7B Corin CTI CEMENTED 5 <1 unclassified Corin CENATOR CEMENTED 4 <1 3A SLR-PLUS CEMENTED 4 <1 unclassified Exactech (UK) ACUMATCH M-SERIES 4 <1 unclassified Waldemar Link MP NECK CEMENTED 4 <1 not applicable Mathys Orthopaedics TWINSYS CEMENTED 3 <1 pre-entry Amplitude INITIALE CEMENTED 2 <1 unclassified B Braun/Aesculap PREVISION CEMENTED 2 <1 not applicable KENT HIP 2 <1 unclassified MODULAR INTERLOC 2 <1 unclassified ENDOPLUS CEMENTED 2 <1 unclassified Orthodynamics LMT 2 <1 7B SL-PLUS CEMENTED 2 <1 unclassified Stanmore Implants CUSTOM DEVICE 2 <1 not applicable Worldwide ACCOLADE CEMENTED 2 <1 unclassified Waldemar Link MEGA SY 2 <1 not applicable SHP 1 <1 unclassified Finsbury FREEMAN CEMENTED FINSBURY 1 <1 10C Orthodynamics CANNULOK CEMENTED 1 <1 not applicable ECHELON CEMENTED 1 <1 unclassified WAGNER REVISION 1 <1 not applicable 12 National Joint Registry

13 National Joint Registry for Engl Wales 6 th Annual Report Table 5(b) Cemented stem brs entered into the NJR during 2008 for revision hip. Manufacturer Br Total components 2,778 Procedures using femoral bone graft EXETER V40 1, CEMENTED ZMR CEMENTED C- CEMENTED CPT REVITAN CEMENTED Waldemar Link MP NECK CEMENTED C- AMT CEMENTED CHARNLEY CEMENTED STANMORE MODULAR CPCS B Braun/Aesculap PREVISION CEMENTED ELITE PLUS CEMENTED B Braun/Aesculap BICONTACT CEMENTED Corin OXFORD UNIVERSAL HIP (CORIN) CEMENTED FURLONG CEMENTED MULLER- BIOMET 14 <1 0 Waldemar Link SP II CEMENTED 14 <1 0 CHARNLEY MODULAR 13 <1 0 LPS 13 <1 0 MS <1 0 MALLORY-HEAD CEMENTED 8 <1 1 TAPERLOC CEMENTED 8 <1 1 CPS-PLUS 8 <1 0 SLR-PLUS CEMENTED 8 <1 3 OXFORD UNIVERSAL HIP (BIOMET) 7 <1 1 CEMENTED Corin TAPERFIT CEMENTED 7 <1 1 WROBLEWSKI RESECTION 6 <1 0 SPECTRON 6 <1 2 OMNIFIT CEMENTED 6 <1 0 Corin TRIFIT CEMENTED 5 <1 0 National Joint Registry 13

14 Manufacturer Br Total components Procedures using femoral bone graft MEM 4 <1 0 ULTIMA STRAIGHT 4 <1 0 Finsbury ADEPT CEMENTED 4 <1 0 Van Straten Medical MUTARS 4 <1 0 KENT HIP 3 <1 0 MULLER STR 3 <1 0 Corin CTI CEMENTED 3 <1 0 Finsbury FREEMAN CEMENTED FINSBURY 3 <1 1 Mathys Orthopaedics CCA CEMENTED 3 <1 0 GMRS 3 <1 1 Wright Medical UK PROFEMUR CEMENTED 3 <1 0 BIMETRIC CEMENTED 2 <1 0 CMK CEMENTED 2 <1 0 Finsbury LIVERPOOL PROXIMAL CEMENTED 2 <1 0 Implants International EDINBURGH 2 <1 0 EXETER 2 <1 0 WAGNER REVISION 2 <1 0 Amplitude INITIALE CEMENTED 1 <1 0 B Braun/Aesculap CENTRAMENT 1 <1 0 B Braun/Aesculap EXCIA-CEMENTED 1 <1 0 Corin FREEMAN CEMENTED CORIN 1 <1 0 SUMMIT CEMENTED 1 <1 0 Exactech (UK) ACUMATCH M-SERIES 1 <1 0 Orthodynamics CANNULOK CEMENTED 1 <1 0 ECHELON CEMENTED 1 <1 0 VERSYS CEMENTED 1 < National Joint Registry

15 National Joint Registry for Engl Wales 6 th Annual Report Table 6(a) Cementless stem brs entered into the NJR during 2008 for primary hip replacements. Manufacturer Br Total components ODEP rating 26,905 CORAIL 12, A FURLONG HAC 3, A ACCOLADE 2, B TAPERLOC 1, A SL-PLUS 1, A CLS A SYNERGY A BIMETRIC A VERSYS various Wright Medical UK PROFEMUR pre-entry ANTHOLOGY pre-entry ABG II B S-ROM A Corin METAFIX pre-entry SUMMIT A BIRMINGHAM HEAD RESECTION pre-entry Mathys Orthopaedics TWINSYS pre-entry Wright Medical UK ANCAFIT 119 <1 3A OMNIFIT 116 <1 10A B Braun/Aesculap EXCIA 95 <1 5A B Braun/Aesculap BICONTACT 88 <1 10A Medacta UK QUADRA 69 <1 unclassified ZWEYMULLER 61 <1 10A Finsbury FREEMAN 55 <1 10C Symbios SA SPS 54 <1 3A Waldemar Link DAVIES 54 <1 unclassified TRABECULAR 49 <1 pre-entry PROXIMA 45 <1 pre-entry B Braun/Aesculap METHA 39 <1 3A ALLOCLASSIC 38 <1 10A KAR 28 <1 not applicable National Joint Registry 15

16 Manufacturer Br Total components ODEP rating ASIAN 17 <1 unclassified Tricon/Medacta QUADRA 17 <1 unclassified Corin PANATOMIC 16 <1 unclassified Finsbury FINSBURY TYPE C 16 <1 pre-entry SILENT 15 <1 unclassified Mathys Orthopaedics CBC 15 <1 pre-entry WAGNER CONE 12 <1 not applicable Corin C FIT 12 <1 unclassified Corin PROXIMA 12 <1 5A AML 11 <1 10B REEF 7 <1 not applicable Orthodynamics CANNULOK 6 <1 not applicable Surgicraft ESOP 5 <1 unclassified CONELOCK 4 <1 unclassified REACH 4 <1 not applicable ECHELON 4 <1 unclassified 4 <1 not applicable SOLUTION 3 <1 unclassified Waldemar Link CFP 3 <1 unclassified Corin TRIFIT 2 <1 unclassified FITMORE 2 <1 unclassified AURA 1 <1 pre-entry BIHAPRO MK III 1 <1 7B Corin HI-NEK 1 <1 unclassified FUTURE 1 <1 unclassified VISION 1 <1 unclassified ENDOPLUS HIP 1 <1 unclassified ImplantCast IMPLANTCAST 1 <1 unclassified Symbios SA SPS HA 1 <1 3A 16 National Joint Registry

17 National Joint Registry for Engl Wales 6 th Annual Report Table 6(b) Cementless stem brs entered into the NJR during 2008 for revision hip replacements. Manufacturer Br Total components Procedures using femoral bone graft 1,242 CORAIL KAR FURLONG HAC S-ROM REEF SOLUTION SYNERGY ECHELON Orthodynamics CANNULOK REACH ACCOLADE Wright Medical UK PROFEMUR SL-PLUS TAPERLOC BIMETRIC CONELOCK VERSYS SUMMIT ANTHOLOGY Corin METAFIX Finsbury FREEMAN CLS 7 <1 0 Mathys Orthopaedics TWINSYS 5 <1 0 ZWEYMULLER 3 <1 0 Corin TRIFIT 3 <1 0 Waldemar Link DAVIES 3 <1 0 B Braun/Aesculap BICONTACT 2 <1 0 B Braun/Aesculap HUCKSTEP 2 <1 0 OMNIFIT 2 <1 1 WAGNER CONE 1 <1 0 Corin C FIT 1 <1 0 Corin HI-NEK 1 <1 0 Corin PANATOMIC 1 <1 0 Corin PROXIMA 1 <1 0 Medacta UK QUADRA 1 <1 0 National Joint Registry 17

18 Table 7 Brs of resurfacing heads entered into the NJR in Manufacturer Br Total components ODEP rating 5,483 BHR RESURFACING HEAD 2, A Finsbury ADEPT RESURFACING HEAD A Corin CORMET 2000 RESURFACING HEAD B ASR RESURFACING HEAD A RECAP RESURFACING HEAD A DUROM RESURFACING HEAD pre-entry Wright Medical UK CONSERVE A MITCH TRH pre-entry ImplantCast ACCIS RESURFACING HEAD 45 1 unclassified Van Straten Medical ACCIS RESURFACING HEAD 16 <1 unclassified MIHR 10 <1 pre-entry Wright Medical UK CONSERVE PLUS HEAD 1 <1 pre-entry Table 8 provides a summary of where brs of resurfacing acetabular cups have been used in combination with a conventional stem a large diameter metal on metal femoral head. This represents a 15 increase on last year. Table 8 Procedures using a resurfacing cup with conventional stem in Manufacturer Br Number of ODEP rating Total 4,433 ASR RESURFACING A BHR RESURFACING A RECAP RESURFACING A Finsbury ADEPT RESURFACING A DUROM RESURFACING pre-entry MITCH TRH pre-entry Corin CORMET 2000 RESURFACING B Wright Medical UK CONSERVE PLUS A MIHR 68 2 unclassified Van Straten Medical ACCIS RESURFACING 31 1 unclassified ImplantCast ACCIS RESURFACING 26 1 unclassified Symbios SA SYMBIOS 13 0 unclassified 18 National Joint Registry

19 National Joint Registry for Engl Wales 6 th Annual Report 1.3 Combinations of cups stems For 54,037 hip primary replacement in the 2008 data, both the cup stem br were known, a total of 690 different combinations of cup stem brs were recorded. This represents a 5 increase over 2007 hip primary. The combinations entered into the NJR are listed in Table 9(a) (b). These tables show primary revision cup-stem combinations. For revision hip, 421 cup-stem combinations were used compared with 416 in The most common cup-stem combination was the Corail stem with the Pinnacle cup for primary the Exeter V40 stem with the Trident cup for revision. Highlighted in the tables are those combinations where the stem manufacturer is different from the cup manufacturer, a practice known as mixing ing. Of the 2008 primary included in this section, 10,134 (19) used mix cup-stem combinations, approximately 1 fewer than in Table 9(a) Cup-stem combinations in the NJR in 2008 for hip primary. Stem manufacturer Stem br Cup manufacturer Cup br Number of 54,037 CORAIL PINNACLE 8, No EXETER V40 CONTEMPORARY 6, No EXETER V40 TRIDENT 3,516 7 No ACCOLADE TRIDENT 2,170 4 No EXETER V40 ELITE PLUS OGEE 2,092 4 Yes FURLONG HAC CSF 1,788 3 No EXETER V40 EXETER DURATION 1,756 3 No FURLONG HAC CSF PLUS 1,241 2 No EXETER V40 TRILOGY 1,196 2 Yes CPT TRILOGY 1,070 2 No SL-PLUS EPF-PLUS 1,052 2 No CPT ZCA No CHARNLEY CEMENTED TAPERLOC CHARNLEY CEMENTED CHARNLEY CEMENTED No EXCEED No CHARNLEY OGEE No EXETER V40 ELITE PLUS CEMENTED CORAIL DURALOC Yes No National Joint Registry 19

20 Stem manufacturer Stem br Cup manufacturer Cup br Number of CORAIL ELITE PLUS CEMENTED No STANMORE STANMORE-ARCOM No MODULAR CORAIL TRILOGY Yes C- AMT CEMENTED ELITE PLUS CEMENTED EXETER V40 REFLECTION No Yes CORAIL ELITE PLUS OGEE No C- CEMENTED ELITE PLUS OGEE No EXETER V40 PINNACLE Yes CPS-PLUS OPERA No VERSYS TRILOGY No EXETER V40 OPERA Yes C- CEMENTED OPERA 265 <1 Yes CPT ELITE PLUS OGEE 255 <1 Yes FURLONG HAC EXETER V40 FURLONG THREADED ABG II 239 <1 No 239 <1 No EXETER V40 Corin CENATOR CEMENTED 238 <1 Yes S-ROM PINNACLE 217 <1 No C- AMT PINNACLE 205 <1 No CEMENTED C- AMT ELITE PLUS OGEE 204 <1 No CEMENTED BIMETRIC M2A CEMENTED 202 <1 No MULLER STR LOW PROFILE MULLER 201 <1 No FURLONG CEMENTED C- CEMENTED SYNERGY FURLONG CEMENTED WROBLEWSKI GOLF BALL REFLECTION 200 <1 No 192 <1 No 189 <1 No CORAIL DURALOC OPTION 178 <1 No CLS ALLOFIT 175 <1 No 20 National Joint Registry

21 National Joint Registry for Engl Wales 6 th Annual Report Stem manufacturer Stem br Cup manufacturer Cup br Number of C- CEMENTED ELITE PLUS CEMENTED 171 <1 No MS-30 LOW PROFILE MULLER 169 <1 No ABG II TRIDENT 169 <1 No MULLER- BIOMET APOLLO 168 <1 No Wright Medical UK CHARNLEY CEMENTED OPERA 164 <1 Yes EXETER V40 ULTIMA CEMENTED 148 <1 Yes PROFEMUR Wright Medical UK PROCOTYL 145 <1 No C- CEMENTED PINNACLE 140 <1 No EXETER V40 EXCEED 135 <1 Yes CPT ALLOFIT 133 <1 No CLS ALLOFIT 130 <1 No Mathys Orthopaedics CCA CEMENTED Mathys Orthopaedics CCB MATHYS 124 <1 No P10 MULLER LOW PROFILE MULLER 121 <1 No EXETER V40 CHARNLEY CEMENTED 120 <1 Yes CPT OPERA 118 <1 Yes CORAIL ABG II CSF 113 <1 Yes ABG II 113 <1 No EXETER V40 CHARNLEY OGEE 113 <1 Yes EXETER V40 TRABECULAR METAL 113 <1 Yes CPCS OPERA 110 <1 No CPT TRABECULAR METAL 105 <1 No STANMORE ARCOM SHP 102 <1 No MODULAR CPCS Endo Plus (UK) POLAR 10 C- CEMENTED CHARNLEY OGEE 97 <1 No CLS TRILOGY 97 <1 No B Braun/Aesculap EXCIA B Braun/Aesculap PLASMA 95 <1 No National Joint Registry 21

22 Stem manufacturer Stem br Cup manufacturer Cup br Number of SL-PLUS BICON-PLUS 94 <1 No ANTHOLOGY REFLECTION OMNIFIT 94 <1 No TRIDENT 94 <1 No MS-30 LOW PROFILE MULLER 92 <1 No B Braun/Aesculap BIMETRIC EXCEED 91 <1 No EXETER V40 ZIMMER CEMENTED 9 SUMMIT PINNACLE 90 <1 No BICONTACT B Braun/Aesculap PLASMA 86 <1 No CHARNLEY MODULAR ELITE PLUS CEMENTED 82 <1 No CPS-PLUS EPF-PLUS 79 <1 No EXETER V40 DURALOC C- CEMENTED SYNERGY 78 <1 Yes CHARNLEY CEMENTED 76 <1 No SP3 76 <1 No EXETER V40 Endo Plus (UK) EPF-PLUS 75 <1 Yes CORAIL MARATHON 75 <1 No Waldemar Link Medacta UK EXETER V40 SP3 74 <1 Yes SP II CEMENTED Waldemar Link INTERPLANTA 74 <1 No QUADRA Medacta UK VERSAFIT 66 <1 No EXETER V40 MALLORY-HEAD 66 <1 Yes CPS-PLUS Corin CENATOR CEMENTED CORAIL ULTIMA CEMENTED Wright Medical UK STANMORE MODULAR TAPERLOC CEMENTED ANCAFIT 65 <1 Yes 63 <1 No ELITE PLUS CEMENTED 62 <1 Yes ARCOM SHP 62 <1 No Wright Medical UK ANCAFIT 62 <1 No FURLONG HAC TRILOGY 62 <1 Yes 22 National Joint Registry

23 National Joint Registry for Engl Wales 6 th Annual Report Stem manufacturer Stem br Cup manufacturer Cup br Number of MS-30 METASUL-WEBER 59 <1 No MULLER- BIOMET LOW PROFILE MULLER 59 <1 Yes SPECTRON REFLECTION 59 <1 No MS-30 ALLOFIT 57 <1 No CMK CEMENTED CMK CEMENTED 57 <1 No VERSYS CEMENTED TRILOGY 57 <1 No CPS-PLUS PE-PLUS 56 <1 No SL-PLUS EXETER V40 POLAR 56 <1 No CSF 55 <1 Yes MULLER STR CENTERPULSE MULLER 55 <1 No Corin TAPERFIT CEMENTED C- CEMENTED CHARNLEY CEMENTED ZIMMER CEMENTED 53 <1 Yes TRILOGY 52 <1 Yes WROBLEWSKI GOLF BALL 52 <1 No CORAIL Mathys Orthopaedics CCB MATHYS 5 CPS-PLUS REFLECTION 49 <1 No CEMENTED CORAIL CONTEMPORARY 49 <1 Yes CORAIL CSF PLUS 48 <1 Yes STANMORE TRILOGY 48 <1 Yes MODULAR SUMMIT ELITE PLUS OGEE 47 <1 No Corin METAFIX DURALOC 45 <1 Yes EXETER V40 FURLONG CEMENTED 44 <1 Yes Symbios SA SPS Symbios SA APRIL 43 <1 No OLYMPIA DURALOC CEMENTED C- AMT CEMENTED TAPERLOC 43 <1 Yes TRIDENT 42 <1 No OPERA 42 <1 Yes CSF 42 <1 Yes National Joint Registry 23

24 Stem manufacturer Stem br Cup manufacturer Cup br Number of Wright Medical UK ANCAFIT Wright Medical UK PROCOTYL 41 <1 No CPT LOW PROFILE MULLER 41 <1 No STANMORE EXCEED 41 <1 No MODULAR TAPERLOC EXCEED 41 <1 No CEMENTED CPT EXCEED 40 <1 Yes EXETER V40 B Braun/Aesculap PLASMA 40 <1 Yes MS-30 ALLOFIT 40 <1 No Finsbury FREEMAN VERSYS Finsbury SLF CEMENTED 40 <1 No (FINSBURY) ALLOFIT 39 <1 No PROXIMA PINNACLE 38 <1 No OMNIFIT CEMENTED CLS SL-PLUS TRIDENT 38 <1 No TRILOGY 38 <1 No OPERA 37 <1 No Mathys Orthopaedics TWINSYS Mathys Orthopaedics SELEXYS PC 35 <1 No B Braun/Aesculap CENTRAMENT B Braun/Aesculap PLASMA 35 <1 No CPS-PLUS POLAR 34 <1 No Corin TAPERFIT CEMENTED Surgicraft SPLIT 34 <1 Yes Wright Medical UK Corin Waldemar Link Waldemar Link PROFEMUR HI-NEK CEMENTED C- AMT CEMENTED C- CEMENTED DAVIES VERSYS CEMENTED SYNERGY SP II CEMENTED DURALOC 32 <1 Yes Corin HI-NEK CEMENTED 31 <1 No ULTIMA CEMENTED 31 <1 No MARATHON 31 <1 No Endo Plus (UK) EPF-PLUS 3 ZCA 31 <1 No TRILOGY 30 <1 Yes Waldemar Link LINK FLANGE 30 <1 No CHARNLEY MODULAR ELITE PLUS OGEE 30 <1 No 24 National Joint Registry

25 National Joint Registry for Engl Wales 6 th Annual Report Stem manufacturer Stem br Cup manufacturer Cup br Number of Corin METAFIX ELITE PLUS CEMENTED 29 <1 Yes CPS-PLUS Ortho-ID POLAR CEMENTED 29 <1 Yes Wright Medical UK Waldemar Link PROFEMUR BIMETRIC ELITE PLUS CEMENTED SP II CEMENTED OMNIFIT CEMENTED TRILOGY 29 <1 Yes MALLORY-HEAD 28 <1 No ELITE PLUS CEMENTED 27 <1 No Waldemar Link SNAP FIT 27 <1 No ODC 27 <1 No Implants International EDINBURGH Implants International EDINBURGH 26 <1 No THRUST PLATE ALLOFIT 26 <1 No ACCOLADE TRILOGY 26 <1 Yes Mathys Orthopaedics TWINSYS Mathys Orthopaedics SELEXYS TH 25 <1 No CHARNLEY MODULAR TRILOGY 24 <1 Yes SL-PLUS Ortho-ID POLAR CEMENTED 23 <1 Yes CORAIL OPERA 23 <1 Yes Corin CLS CLS 23 <1 No FURLONG HAC ELITE PLUS OGEE 23 <1 Yes TAPERLOC TAPERFIT CEMENTED Mathys Orthopaedics CCA CEMENTED ARCOM SHP 22 <1 No REFLECTION 22 <1 Yes CEMENTED Implants International CCB 22 <1 Yes CORAIL TRABECULAR METAL 22 <1 Yes ZWEYMULLER TRILOGY 22 <1 No TRABECULAR TRILOGY 22 <1 No EXETER V40 Surgicraft SPLIT 2 KAR PINNACLE 20 <1 No ELITE PLUS CEMENTED STANMORE MODULAR ELITE PLUS OGEE 20 <1 No ELITE PLUS OGEE 19 <1 Yes National Joint Registry 25

26 Stem manufacturer Stem br Cup manufacturer Cup br Number of CPCS REFLECTION FURLONG HAC CPT Waldemar Link OMNIFIT CEMENTED SP II CEMENTED 19 <1 No FURLONG CEMENTED 19 <1 No CONTEMPORARY 19 <1 Yes CONTEMPORARY 18 <1 No Endo Plus (UK) EPF-PLUS 18 <1 Yes CPT DURALOC Tricon/Medacta SL-PLUS QUADRA 18 <1 Yes Mathys Orthopaedics RM 17 <1 Yes (MATHYS) Medacta UK VERSAFIT 17 <1 Yes SPECTRON OPERA 17 <1 No Wright Medical UK OMNIFIT CEMENTED ZCA 17 <1 Yes ACCOLADE TRABECULAR METAL 16 <1 Yes EXETER V40 TRITANIUM 16 <1 No PROFEMUR Wright Medical UK LINEAGE 16 <1 No C- AMT MARATHON 16 <1 No CEMENTED C- CEMENTED C- CEMENTED B Braun/Aesculap ULTIMA CEMENTED PLASMA 16 <1 No 16 <1 Yes B Braun/Aesculap CENTRAMENT B Braun/Aesculap CHIRULEN 15 <1 No ZWEYMULLER ALLOFIT 15 <1 No Wright Medical UK Corin PROFEMUR PANATOMIC OMNIFIT Corin CENATOR CEMENTED 15 <1 Yes Corin DC-FIT 15 <1 No SECURE FIT CPT ULTIMA CEMENTED CHARNLEY CEMENTED WROBLEWSKI ANGLE BORE SOCKET 15 <1 No 15 <1 Yes 14 <1 No CHARNLEY MODULAR CHARNLEY OGEE 14 <1 No SL-PLUS TRILOGY 14 <1 Yes OLYMPIA TRILOGY 13 <1 Yes 26 National Joint Registry

27 National Joint Registry for Engl Wales 6 th Annual Report Stem manufacturer Stem br Cup manufacturer Cup br Number of CORAIL ZCA 13 <1 Yes CPT PINNACLE 13 <1 Yes MS-30 METASUL-WEBER 13 <1 No TAPERLOC M2A CEMENTED 13 <1 No CPCS Endo Plus (UK) EPF-PLUS 13 <1 Yes MULLER- BIOMET Mathys Orthopaedics CCB MATHYS 13 <1 Yes CORAIL Waldemar Link ACCOLADE DAVIES CLS TRIDENT 13 <1 Yes SECURE FIT 13 <1 No Waldemar Link MCMINN 13 <1 No TRABECULAR METAL 13 <1 No EXETER V40 Waldemar Link LINK FLANGE 13 <1 Yes ACCOLADE CONTEMPORARY 12 <1 No Corin METAFIX CONTEMPORARY 12 <1 Yes BIMETRIC CEMENTED ARCOM SHP 12 <1 No BIMETRIC UNIVERSAL II 12 <1 No Waldemar Link DAVIES PINNACLE 12 <1 Yes EXETER V40 MARATHON 12 <1 Yes EXETER V40 ZCA 12 <1 Yes CORAIL ZIMMER CEMENTED 12 <1 Yes MS-30 TRILOGY 12 <1 No CLS ALLOCLASSIC VERSYS ULTIMA STRAIGHT TRABECULAR METAL 12 <1 No TRILOGY 12 <1 No TRABECULAR METAL ULTIMA CEMENTED 11 <1 No 11 <1 No AML DURALOC OPTION 11 <1 No EXETER V40 LOW PROFILE MULLER 1 National Joint Registry 27

28 Stem manufacturer Stem br Cup manufacturer Cup br Number of MS-30 FITMORE 11 <1 No EXETER V40 STANMORE MODULAR CPT Wright Medical UK EXETER PROFEMUR CEMENTED OMNIFIT CEMENTED ALLOCLASSIC SECURE FIT 11 <1 No TRIDENT 1 TRIDENT 1 TRIDENT 10 <1 No Wright Medical UK PROCOTYL 10 <1 No EXETER DURATION 10 <1 No OPERA 10 <1 Yes SPECTRON REFLECTION 10 <1 No CEMENTED B Braun/Aesculap EXCIA-CEMENTED B Braun/Aesculap CHIRULEN 10 <1 No Corin BIMETRIC CEMENTED TAPERFIT CEMENTED STANMORE MODULAR TAPERLOC APOLLO 10 <1 No Corin CENATOR CEMENTED 10 <1 No PINNACLE 10 <1 Yes PINNACLE 10 <1 Yes ANTHOLOGY TRABECULAR METAL CLS SL-PLUS TAPERLOC STANMORE MODULAR 10 <1 Yes ZIMMER CEMENTED 9 <1 No ELITE PLUS OGEE 9 <1 Yes MALLORY-HEAD 9 <1 No M2A CEMENTED 9 <1 No B Braun/Aesculap EXCIA-CEMENTED B Braun/Aesculap PLASMA 9 <1 No MEM LOW PROFILE MULLER 9 <1 No CPT MALLORY-HEAD Mathys Orthopaedics TWINSYS Mathys Orthopaedics RM (MATHYS) 9 <1 Yes 9 <1 No Mathys Orthopaedics CBC Mathys Orthopaedics SELEXYS TH 9 <1 No ASIAN EXETER DURATION 9 <1 Yes 28 National Joint Registry

29 National Joint Registry for Engl Wales 6 th Annual Report Stem manufacturer Stem br Cup manufacturer Cup br Number of CPS-PLUS CONTEMPORARY 9 <1 Yes ANTHOLOGY SP3 9 <1 No ZWEYMULLER TRABECULAR METAL Wright Medical UK Waldemar Link Wright Medical UK C- CEMENTED ANCAFIT SP II CEMENTED PROFEMUR CEMENTED 9 <1 No TRABECULAR METAL 8 <1 Yes Wright Medical UK LINEAGE 8 <1 No Waldemar Link PROCOTYL 8 <1 No TRIDENT 8 <1 Yes CPCS Ortho-ID POLAR CEMENTED 8 <1 Yes CPS-PLUS Mathys Orthopaedics RM (MATHYS) EXETER V40 REFLECTION CEMENTED 8 <1 Yes 8 <1 Yes Corin METAFIX Amplitude EQUATEUR 8 <1 Yes Corin METAFIX Amplitude HORIZON 8 <1 Yes CHARNLEY CEMENTED Corin CENATOR CEMENTED CORAIL Corin CENATOR CEMENTED Corin TAPERLOC TAPERFIT CEMENTED SL-PLUS ELITE PLUS CEMENTED DURALOC ELITE PLUS CEMENTED 8 <1 Yes 8 <1 Yes 8 <1 Yes 8 <1 Yes 8 <1 Yes VERSYS HERITAGE TRILOGY 8 <1 No SPECTRON TRILOGY 8 <1 Yes Corin TAPERFIT CEMENTED ELITE PLUS OGEE 7 <1 Yes MS-30 SPC 7 <1 No EXETER ELITE PLUS OGEE 7 <1 Yes CPS-PLUS ELITE PLUS OGEE 7 <1 Yes MULLER- BIOMET PINNACLE 7 <1 Yes SUMMIT Amplitude SATURNE 7 <1 Yes B Braun/Aesculap METHA B Braun/Aesculap PLASMA 7 <1 No EXETER V40 BIOMEX 7 <1 Yes National Joint Registry 29

30 Stem manufacturer Stem br Cup manufacturer Cup br Number of P10 MULLER METASUL-MULLER 7 <1 No FURLONG CEMENTED CPT OMNIFIT CEMENTED EXETER V40 CSF 7 <1 No SECURE FIT 7 <1 Yes SECURE FIT 6 <1 No GAP RING 6 <1 No ALLOCLASSIC Ortho-ID POLAR CEMENTED 6 <1 Yes EXETER V40 Mathys Orthopaedics RM 6 <1 Yes (MATHYS) C- CEMENTED WROBLEWSKI ANGLE BORE SOCKET 6 <1 No P10 MULLER ALLOFIT 6 <1 No Corin HI-NEK CEMENTED SUMMIT CEMENTED TAPERLOC ALLOFIT 6 <1 Yes ULTIMA CEMENTED TRABECULAR METAL MS-30 TRABECULAR METAL MULLER STR ZIMMER CEMENTED CLS ZIMMER CEMENTED CPT ZIMMER CEMENTED Wright Medical UK VERSYS ZMR CEMENTED TRABECULAR ASIAN PROFEMUR 6 <1 No 6 <1 Yes 6 <1 No 6 <1 No 6 <1 No 5 <1 No ZIMMER CEMENTED 5 <1 No TRILOGY 5 <1 No TRABECULAR METAL 5 <1 No TRILOGY 5 <1 Yes TRABECULAR METAL 5 <1 Yes MS-30 TRILOGY 5 <1 No Mathys Orthopaedics CCA CEMENTED Wright Medical UK PROFEMUR ELITE PLUS CEMENTED TRILOGY 5 <1 Yes PINNACLE 5 <1 Yes PINNACLE 5 <1 No 30 National Joint Registry

31 National Joint Registry for Engl Wales 6 th Annual Report Stem manufacturer Stem br Cup manufacturer Cup br Number of SL-PLUS ELITE PLUS CEMENTED C- CEMENTED C- AMT CEMENTED CLS Corin CENATOR CEMENTED 5 <1 Yes CHARNLEY OGEE 5 <1 No DURALOC 5 <1 No MALLORY-HEAD 5 <1 Yes CLS 5 <1 No MS-30 METASUL-MULLER 5 <1 No EXETER ULTIMA CEMENTED 5 <1 Yes CPCS Endo Plus (UK) PE-PLUS 5 <1 Yes ANTHOLOGY Endo Plus (UK) EPF-PLUS 5 <1 Yes MULLER STR CSF PLUS 5 <1 Yes CORAIL Mathys Orthopaedics RM (MATHYS) 5 <1 Yes EXETER V40 FURLONG HAC GAP2 5 <1 No CONTEMPORARY 5 <1 Yes Surgicraft ESOP Surgicraft SPLIT 5 <1 No CPT Surgicraft SPLIT 5 <1 Yes Wright Medical UK C- AMT CEMENTED PROFEMUR Wright Medical UK SECURE FIT ANCAFIT MS-30 TRABECULAR METAL Exactech (UK) REVITAN CEMENTED VERSYS CEMENTED ACUMATCH M-SERIES OMNIFIT EXETER TRABECULAR METAL 5 <1 Yes 5 <1 No 5 <1 No 5 <1 No Wright Medical UK PROCOTYL 4 <1 Yes TRIDENT 4 <1 Yes CONTEMPORARY 4 <1 No CONTEMPORARY 4 <1 No EXETER V40 Orthodynamics NOVAE SF 4 <1 Yes CPS-PLUS REFLECTION 4 <1 No National Joint Registry 31

32 Stem manufacturer Stem br Cup manufacturer Cup br Number of Waldemar Link SP II CEMENTED EXETER V40 Mathys Orthopaedics TWINSYS Implants International CSF 4 <1 Yes CSF PLUS 4 <1 Yes RM (IMPLANTS INTERNATIONAL) 4 <1 Yes CPT Endo Plus (UK) EPF-PLUS 4 <1 Yes SL-PLUS PE-PLUS 4 <1 No CPCS Endo Plus (UK) BOFOR 4 <1 Yes ALLOCLASSIC ALLOFIT 4 <1 No C- AMT BIOMEX 4 <1 Yes CEMENTED ANTHOLOGY EXCEED 4 <1 Yes B Braun/Aesculap BICONTACT CEMENTED B Braun/Aesculap PLASMA 4 <1 No CONELOCK Amplitude SATURNE 4 <1 Yes CHARNLEY MODULAR CHARNLEY CEMENTED Corin EXETER ELITE PLUS CEMENTED CENATOR CEMENTED FURLONG CEMENTED 4 <1 No 4 <1 Yes Corin CENATOR CEMENTED 4 <1 No PINNACLE 4 <1 Yes FURLONG HAC PINNACLE 4 <1 Yes FURLONG HAC ULTIMA CEMENTED 4 <1 Yes Corin METAFIX PINNACLE 4 <1 Yes S-ROM TRILOGY 4 <1 Yes C- AMT TRILOGY 4 <1 Yes CEMENTED Corin METAFIX TRILOGY 4 <1 Yes MS-30 ZCA 4 <1 No OLYMPIA ZCA 4 <1 Yes Mathys Orthopaedics CCA CEMENTED C- CEMENTED FURLONG HAC ZCA 4 <1 Yes ZIMMER CEMENTED ZIMMER CEMENTED 4 <1 Yes 3 <1 Yes 32 National Joint Registry

33 National Joint Registry for Engl Wales 6 th Annual Report Stem manufacturer Stem br Cup manufacturer Cup br Number of CLS ZCA 3 <1 No WAGNER CONE TRILOGY 3 <1 No OMNIFIT CEMENTED ALLOCLASSIC TRILOGY 3 <1 Yes TRABECULAR METAL FURLONG HAC TRABECULAR METAL S-ROM TRABECULAR METAL 3 <1 No 3 <1 Yes 3 <1 Yes MULLER STR PINNACLE 3 <1 Yes KAR ELITE PLUS OGEE 3 <1 No EXETER V40 S-ROM STANMORE MODULAR CLS 3 <1 Yes ULTIMA CEMENTED 3 <1 Yes PINNACLE 3 <1 Yes WAGNER CONE PINNACLE 3 <1 Yes FURLONG HAC ELITE PLUS CEMENTED 3 <1 Yes TAPERLOC ELITE PLUS OGEE 3 <1 Yes CORAIL CHARNLEY CEMENTED 3 <1 No CORAIL CHARNLEY OGEE 3 <1 No CPS-PLUS B Braun/Aesculap ALFA CEMENTED 3 <1 Yes OLYMPIA APOLLO 3 <1 No Wright Medical UK TAPERLOC PROFEMUR STANMORE MODULAR MALLORY-HEAD CEMENTED APOLLO 3 <1 No EXCEED 3 <1 Yes MALLORY-HEAD 3 <1 No EXCEED 3 <1 No MS-30 FITMORE 3 <1 No BIMETRIC STANMORE-ARCOM 3 <1 No MS-30 SPC 3 <1 No STANMORE RANAWAT/BURSTEIN 3 <1 No MODULAR CHARNLEY MODULAR WROBLEWSKI GOLF BALL 3 <1 No National Joint Registry 33

34 Stem manufacturer Stem br Cup manufacturer Cup br Number of EXETER V40 Implants International EDINBURGH 3 <1 Yes SL-PLUS REFLECTION 3 <1 No Mathys Orthopaedics CBC Mathys Orthopaedics SELEXYS 3 <1 No SUMMIT CEMENTED GAP2 3 <1 Yes SECURE FIT 3 <1 No SPECTRON SP3 3 <1 No Wright Medical UK PROFEMUR ACCOLADE TRIDENT 3 <1 Yes TRITANIUM 3 <1 No Waldemar Link CFP Waldemar Link PRESSFIT 3 <1 No EXETER V40 Wright Medical UK PROCOTYL 3 <1 Yes CORAIL Wright Medical UK PROCOTYL 3 <1 Yes S-ROM DURALOC 3 <1 No OLYMPIA Wright Medical UK PROCOTYL 2 <1 Yes CORAIL Wright Medical UK ANCAFIT WAGNER CONE TRABECULAR METAL Corin TAPERFIT CEMENTED S-ROM SYNERGY C- CEMENTED 2 <1 Yes 2 <1 No TRABECULAR METAL 2 <1 Yes TRIDENT 2 <1 Yes TRIDENT 2 <1 Yes TRIDENT 2 <1 No CONTEMPORARY 2 <1 Yes CPCS CONTEMPORARY 2 <1 Yes CPCS SP3 2 <1 No CPT ASIAN STANMORE MODULAR TAPERLOC ABG II 2 <1 Yes CONTEMPORARY 2 <1 Yes CONTEMPORARY 2 <1 Yes CONTEMPORARY 2 <1 Yes 34 National Joint Registry

35 National Joint Registry for Engl Wales 6 th Annual Report Stem manufacturer Stem br Cup manufacturer Cup br Number of CPT MALLORY-HEAD CEMENTED TAPERLOC GAP2 2 <1 Yes SECURE FIT SECURE FIT 2 <1 Yes 2 <1 Yes CORAIL Orthodynamics NOVAE 2 <1 Yes FURLONG HAC Orthodynamics NOVAE SF 2 <1 Yes CORAIL REFLECTION CEMENTED 2 <1 Yes SL-PLUS BIRMINGHAM HEAD RESECTION REFLECTION CEMENTED REFLECTION 2 <1 No 2 <1 No REEF OPERA 2 <1 Yes SL-PLUS CEMENTED EPF-PLUS 2 <1 No MULLER STR CSF 2 <1 Yes Finsbury Orthodynamics CHARNLEY CEMENTED EXETER V40 Implants International RM (IMPLANTS INTERNATIONAL) LIVERPOOL PROXIMAL CEMENTED ALLOCLASSIC CLS S-ROM CANNULOK Finsbury Endo Plus (UK) CSF 2 <1 Yes SLF CEMENTED (FINSBURY) EXETER V40 WROBLEWSKI GOLF BALL 2 <1 Yes 2 <1 No POLAR 2 <1 Yes CSF PLUS 2 <1 Yes CSF PLUS 2 <1 Yes CSF 2 <1 Yes 2 <1 Yes CORAIL Endo Plus (UK) EPF-PLUS 2 <1 Yes CPT REGENEREX 2 <1 Yes FURLONG HAC STANMORE-ARCOM 2 <1 Yes C- CEMENTED TAPERLOC CEMENTED MALLORY-HEAD PAR 5 RINOWL 2 <1 Yes 2 <1 No National Joint Registry 35

36 Stem manufacturer Stem br Cup manufacturer Cup br Number of FURLONG HAC ALLOFIT 2 <1 Yes Mathys Orthopaedics CCA CEMENTED LOW PROFILE MULLER 2 <1 Yes EXETER V40 CLS 2 <1 Yes BIMETRIC CEMENTED EXCEED 2 <1 No CORAIL EXCEED 2 <1 Yes BIMETRIC STANMORE MODULAR CHARNLEY CEMENTED BIOMEX 2 <1 No BIOMEX 2 <1 No MALLORY-HEAD CORAIL MALLORY-HEAD MALLORY-HEAD CEMENTED MALLORY-HEAD 2 <1 Yes 2 <1 Yes 2 <1 No MULLER STR APOLLO 2 <1 Yes BIMETRIC ARCOM SHP 2 <1 No MODULAR INTERLOC ARCOM SHP 2 <1 No MALLORY-HEAD CEMENTED BIOMET BI-POLAR CEMENTED 2 <1 No PROXIMA Amplitude SATURNE 2 <1 Yes B Braun/Aesculap PREVISION CEMENTED B Braun/Aesculap PLASMA CPT CHARNLEY CEMENTED KAR DURALOC ELITE PLUS CEMENTED CHARNLEY CEMENTED 2 <1 No 2 <1 Yes 2 <1 No 2 <1 No EXETER DURALOC 2 <1 Yes S-ROM DURALOC OPTION 2 <1 No CHARNLEY MODULAR PINNACLE 2 <1 No SOLUTION PINNACLE 2 <1 No ULTIMA STRAIGHT PINNACLE 2 <1 No REEF ELITE PLUS OGEE 2 <1 No Wright Medical UK PROFEMUR ELITE PLUS OGEE 2 <1 Yes 36 National Joint Registry

37 National Joint Registry for Engl Wales 6 th Annual Report Stem manufacturer Stem br Cup manufacturer Cup br Number of SL-PLUS TRABECULAR METAL 2 <1 Yes CPCS TRABECULAR METAL 2 <1 Yes MULLER STR TRILOGY 2 <1 No Wright Medical UK ZMR CEMENTED PROFEMUR CEMENTED TRABECULAR METAL 2 <1 No TRILOGY 2 <1 Yes EXETER TRILOGY 2 <1 Yes ELITE PLUS CEMENTED TRILOGY 2 <1 Yes KAR TRILOGY 2 <1 Yes ANTHOLOGY TRILOGY 2 <1 Yes S-ROM ELITE PLUS OGEE 2 <1 No ECHELON CEMENTED TRILOGY ECHELON TRILOGY REEF TRILOGY Corin CTI CEMENTED TRILOGY Finsbury ADEPT CEMENTED TRILOGY Waldemar Link SP II CEMENTED TRILOGY FITMORE TRILOGY 1 <1 No TAPERLOC TRILOGY CEMENTED TAPERLOC TRILOGY REVITAN CEMENTED TRILOGY 1 <1 No BIMETRIC CEMENTED TRILOGY VERSYS HERITAGE TRABECULAR METAL 1 <1 No VERSYS CEMENTED ECHELON SYNERGY TRABECULAR METAL TRABECULAR METAL TRABECULAR METAL CPS-PLUS TRABECULAR METAL 1 <1 No National Joint Registry 37

38 Stem manufacturer Stem br Cup manufacturer Cup br Number of Mathys Orthopaedics CCA CEMENTED Medacta UK Amplitude OMNIFIT CEMENTED CEMENTED QUADRA STANMORE MODULAR CLS INITIALE CEMENTED C- AMT CEMENTED C- CEMENTED TRABECULAR METAL TRABECULAR METAL TRABECULAR METAL ZCA ZCA ZCA 1 <1 No ZCA ZCA ZCA CPS-PLUS ZCA ZMR CEMENTED ZCA 1 <1 No MS-30 ZCA 1 <1 No ANTHOLOGY ZIMMER CEMENTED Finsbury ADEPT CEMENTED ELITE PLUS OGEE ABG II ELITE PLUS OGEE ACCOLADE ELITE PLUS OGEE SUMMIT CEMENTED REVITAN CEMENTED CHARNLEY CEMENTED S-ROM CLS ELITE PLUS OGEE 1 <1 No PINNACLE PINNACLE 1 <1 No MARATHON 1 <1 No HYLAMER P10 MULLER HYLAMER SOLUTION HYLAMER 1 <1 No CHARNLEY HYLAMER OGEE 1 <1 No CEMENTED CPS-PLUS PINNACLE 38 National Joint Registry

39 National Joint Registry for Engl Wales 6 th Annual Report Stem manufacturer Stem br Cup manufacturer Cup br Number of SUMMIT CEMENTED PINNACLE 1 <1 No Orthodynamics CANNULOK PINNACLE CPCS PINNACLE Orthodynamics VERSYS PINNACLE ZMR CEMENTED PINNACLE ACCOLADE S-ROM CANNULOK VERSYS CEMENTED DURALOC DURALOC AML ELITE PLUS OGEE 1 <1 No Waldemar Link MP NECK CEMENTED ELITE PLUS CEMENTED CPT ELITE PLUS CEMENTED C- CEMENTED ELITE PLUS FLANGED 1 <1 No EXETER V40 ELITE PLUS FLANGED S-ROM BIMETRIC CEMENTED C- AMT CEMENTED FURLONG CEMENTED TAPERLOC Corin Corin ELITE PLUS CEMENTED CHARNLEY CEMENTED CHARNLEY CEMENTED CENATOR CEMENTED CENATOR CEMENTED REEF DURALOC STANMORE MODULAR DURALOC 1 <1 No 1 <1 No 1 <1 No P10 MULLER DURALOC CPT CHARNLEY OGEE B Braun/Aesculap BICONTACT CEMENTED DURALOC FUTURE CHARNLEY OGEE 1 <1 No C- AMT CEMENTED CHARNLEY OGEE 1 <1 No National Joint Registry 39

40 Stem manufacturer Stem br Cup manufacturer Cup br Number of CORAIL B Braun/Aesculap PLASMA B Braun/Aesculap SL-PLUS B Braun/Aesculap ALFA CEMENTED BICONTACT B Braun/Aesculap CHIRULEN 1 <1 No CEMENTED ACCOLADE Amplitude SATURNE TAPERLOC Mathys Orthopaedics TWINSYS CEMENTED BIOMET BI-POLAR CEMENTED BIOMET BI-POLAR CEMENTED 1 <1 No MULLER- BIOMET BIOMET MULLER 1 <1 No EXETER V40 ARCOM SHP CPT ARCOM SHP BIHAPRO MK III BIHAPRO 1 <1 No MONOBLOC ARCOM SHP 1 <1 No STANMORE FURLONG HAC APOLLO Mathys Orthopaedics CCA CEMENTED BIMETRIC CEMENTED OMNIFIT CEMENTED TAPERLOC BIMETRIC APOLLO MALLORY-HEAD 1 <1 No EXCEED EXCEED BIOMEX 1 <1 No CUSTOM HC 1 <1 No FURLONG HAC EXCEED Mathys Orthopaedics TWINSYS CEMENTED EXCEED Wright Medical UK PROFEMUR CLS C- AMT CENTERPULSE MULLER CEMENTED Orthodynamics LMT CENTERPULSE MULLER TAPERLOC LOW PROFILE MULLER CLS LOW PROFILE MULLER 1 <1 No WAGNER CONE FITMORE 1 <1 No 40 National Joint Registry

41 National Joint Registry for Engl Wales 6 th Annual Report Stem manufacturer Stem br Cup manufacturer Cup br Number of C- AMT LOW PROFILE MULLER CEMENTED CLS LOW PROFILE MULLER 1 <1 No CLS METASUL-MULLER 1 <1 No CPT METASUL-WEBER 1 <1 No MS-30 METASUL-MULLER 1 <1 No Mathys Orthopaedics CBC ALLOFIT EXETER V40 ALLOFIT OMNIFIT CEMENTED ALLOFIT FITMORE ALLOFIT 1 <1 No MAYO CEMENTED ALLOFIT 1 <1 No Corin HI-NEK ALLOFIT CORAIL ALLOFIT SOLUTION ALLOFIT BIMETRIC ALLOFIT MULLER STR ALLOFIT 1 <1 No CORAIL PAR 5 RINOWL CPS-PLUS MALLORY-HEAD SL-PLUS MALLORY-HEAD CPCS MALLORY-HEAD BIMETRIC CEMENTED UNIVERSAL II 1 <1 No SL-PLUS STANMORE-ARCOM CPS-PLUS RINGLOC FURLONG HAC SCAN CEMENTED CORAIL RANAWAT/BURSTEIN Corin C- CEMENTED HI-NEK CEMENTED Endo Plus (UK) EPF-PLUS Endo Plus (UK) EPF-PLUS National Joint Registry 41

42 Stem manufacturer Stem br Cup manufacturer Cup br Number of SL-PLUS C- AMT CEMENTED SL-PLUS BOFOR 1 <1 No WROBLEWSKI GOLF 1 <1 No BALL EPF-PLUS 1 <1 No REACH Endo Plus (UK) POLAR PROXIMA Endo Plus (UK) POLAR SLR-PLUS CEMENTED EPF-PLUS 1 <1 No Finsbury ADEPT CEMENTED Endo Plus (UK) EPF-PLUS Corin CTI CEMENTED CSF PLUS Wright Medical UK PROFEMUR CLS CPT VERSYS MULLER- BIOMET Finsbury Finsbury Type C Wright Medical UK Finsbury FURLONG CEMENTED FURLONG HAC PROFEMUR FREEMAN CEMENTED FINSBURY MALLORY-HEAD CEMENTED STANMORE MODULAR TAPERLOC CEMENTED C- AMT CEMENTED C- CEMENTED Finsbury Corin C FIT CSF CSF CSF CSF CSF PLUS CSF PLUS CSF PLUS 1 <1 No CUSTOM 1 <1 No CSF PLUS SLF CEMENTED 1 <1 No (FINSBURY) CSF CSF CSF CSF CSF CSF 42 National Joint Registry

43 National Joint Registry for Engl Wales 6 th Annual Report Stem manufacturer Stem br Cup manufacturer Cup br Number of CORAIL Implants International RM (IMPLANTS INTERNATIONAL) Corin TAPERFIT CEMENTED OPERA CHARNLEY MODULAR OPERA SUMMIT OPERA CPS-PLUS POLAR 1 <1 No Corin METAFIX REFLECTION CEMENTED SLR-PLUS CEMENTED OPERA 1 <1 No ECHELON REFLECTION 1 <1 No CPT REFLECTION CPCS REFLECTION 1 <1 No CEMENTED C- CEMENTED Orthodynamics NOVAE STICK Orthodynamics LMT Orthodynamics ORTHODYNAMICS 1 <1 No ENDOPLUS EPF-PLUS 1 <1 No CEMENTED CORAIL Orthodynamics NOVAE SF Medacta UK CMK CEMENTED C- CEMENTED QUADRA SLR-PLUS CEMENTED ACCOLADE Mathys Orthopaedics SELEXYS PC Mathys Orthopaedics Mathys Orthopaedics Mathys Orthopaedics RM (MATHYS) RM (MATHYS) RM (MATHYS) FURLONG CEMENTED EXETER V40 Mathys Orthopaedics CCB MATHYS KENT HIP Mathys Orthopaedics RM (MATHYS) Corin TAPERFIT CEMENTED FURLONG HAC ACCOLADE ZMR CEMENTED SECURE FIT GAP2 GAP2 1 <1 No SECURE FIT National Joint Registry 43

44 Stem manufacturer Stem br Cup manufacturer Cup br Number of OLYMPIA CHARNLEY CEMENTED C- CEMENTED S-ROM VERSYS PROXIMA TAPERLOC CEMENTED CLS CORAIL EXETER V40 Implants International EDINBURGH FURLONG HAC ACCOLADE CPT CHARNLEY MODULAR Corin SUMMIT FURLONG HAC ACCOLADE HI-NEK CEMENTED TAPERLOC CEMENTED BIMETRIC CEMENTED REACH SHP EXETER TRIDENT TRIDENT TRIDENT TRIDENT ODC GAP2 ODC ODC ODC ODC 1 <1 No EXETER DURATION EXETER DURATION EXETER DURATION 1 <1 No EXETER DURATION GAP RING GAP RING GAP RING GAP RING 1 <1 No CONTEMPORARY CONTEMPORARY CONTEMPORARY CONTEMPORARY CONTEMPORARY ARDEN 1 <1 No 44 National Joint Registry

45 National Joint Registry for Engl Wales 6 th Annual Report Stem manufacturer Stem br Cup manufacturer Cup br Number of ACCOLADE TAPERLOC SYNERGY Mathys Orthopaedics TWINSYS ANTHOLOGY Waldemar Link Wright Medical UK ImplantCast Waldemar Link Wright Medical UK Stanmore Implants Worldwide Orthodynamics CEMENTED MP NECK CEMENTED PROFEMUR ELITE PLUS CEMENTED S-ROM IMPLANTCAST MP NECK CEMENTED ANCAFIT CUSTOM DEVICE ACCOLADE CEMENTED CANNULOK SPECTRON CEMENTED ABG II 1 <1 No ABG II CONTEMPORARY CONTEMPORARY CONTEMPORARY CONTEMPORARY 1 <1 No CONTEMPORARY 1 <1 No CONTEMPORARY CONTEMPORARY CONTEMPORARY CONTEMPORARY CONTEMPORARY TRIDENT TRIDENT TRIDENT TRIDENT 1 <1 No TRIDENT TRIDENT TRITANIUM 1 <1 No EXETER V40 Waldemar Link MCMINN ZMR CEMENTED VERSYS TRIDENT Surgicraft SPLIT EXETER V40 Symbios SA APRIL S-ROM TRABECULAR METAL National Joint Registry 45

46 Stem manufacturer Stem br Cup manufacturer Cup br Number of C- AMT CEMENTED BIMETRIC TRABECULAR METAL TRABECULAR METAL REACH TRABECULAR METAL EXETER V40 Wright Medical UK ANCAFIT Corin METAFIX Wright Medical UK ANCAFIT P10 MULLER Wright Medical UK PROCOTYL Wright Medical UK PROFEMUR CEMENTED ULTIMA STRAIGHT Wright Medical UK LINEAGE 1 <1 No Wright Medical UK PROCOTYL 46 National Joint Registry

47 National Joint Registry for Engl Wales 6 th Annual Report Table 9(b) Cup-stem combinations in the NJR in 2008 for hip revision where both were implanted during the revision. Stem manufacturer Stem br Cup manufacturer Cup br Number of 3,161 EXETER V40 EXETER V40 CEMENTED TRIDENT No CONTEMPORARY No TRIDENT No CORAIL PINNACLE No KAR PINNACLE No EXETER V40 TRILOGY 94 3 Yes EXETER V40 TRABECULAR METAL 83 3 Yes ZMR CEMENTED TRILOGY 69 2 No ZMR CEMENTED TRABECULAR METAL 68 2 No CPT TRABECULAR METAL 57 2 No S-ROM PINNACLE 56 2 No REVITAN CEMENTED TRABECULAR METAL 50 2 No EXETER V40 ELITE PLUS OGEE 50 2 Yes C- CEMENTED CEMENTED SOLUTION ELITE PLUS OGEE 47 1 No TRABECULAR METAL 46 1 Yes PINNACLE 44 1 No EXETER V40 REFLECTION EXETER V40 ELITE PLUS CEMENTED CEMENTED EXETER V Yes 40 1 Yes TRITANIUM 39 1 No TRITANIUM 37 1 No EXETER V40 PINNACLE 35 1 Yes FURLONG HAC EXETER V40 CEMENTED CSF PLUS 33 1 No EXETER DURATION 33 1 No CONTEMPORARY 30 1 No National Joint Registry 47

48 Stem manufacturer Stem br Cup manufacturer Cup br Number of FURLONG HAC C- CEMENTED C- CEMENTED CSF 28 1 No PINNACLE 26 1 No OPERA 23 1 Yes REEF PINNACLE 23 1 No CPT TRILOGY 23 1 No CEMENTED CHARNLEY CEMENTED C- AMT CEMENTED CEMENTED ACCOLADE C- CEMENTED C- CEMENTED TRILOGY 22 1 Yes CHARNLEY CEMENTED 22 1 No PINNACLE 21 1 No PINNACLE 20 1 Yes TRIDENT 20 1 No WROBLEWSKI GOLF BALL ELITE PLUS CEMENTED 19 1 No 19 1 No CPT ZCA 18 1 No REACH MALLORY-HEAD Waldemar Link Corin MP NECK CEMENTED SUMMIT 17 1 No TRABECULAR METAL 16 1 Yes Amplitude SATURNE 15 <1 Yes EXETER V40 Corin CENATOR CEMENTED FURLONG HAC CEMENTED FURLONG THREADED REFLECTION 13 <1 Yes 12 <1 No 12 <1 Yes EXETER V40 OPERA 12 <1 Yes OXFORD UNIVERSAL HIP (CORIN) CEMENTED ECHELON TRILOGY 12 <1 Yes TRILOGY 12 <1 Yes KAR TRABECULAR METAL CPCS REFLECTION 1 11 <1 No 48 National Joint Registry

49 National Joint Registry for Engl Wales 6 th Annual Report Stem manufacturer Stem br Cup manufacturer Cup br Number of B Braun/Aesculap SYNERGY PREVISION CEMENTED ELITE PLUS CEMENTED B Braun/Aesculap REFLECTION PLASMA ELITE PLUS CEMENTED 11 <1 No 10 <1 No 10 <1 No CPT ELITE PLUS OGEE 9 <1 Yes KAR ELITE PLUS OGEE 9 <1 No CONELOCK Amplitude SATURNE 9 <1 Yes TAPERLOC EXCEED 9 <1 No EXETER V40 MALLORY-HEAD 9 <1 Yes KAR OPERA 9 <1 Yes Waldemar Link B Braun/Aesculap Waldemar Link EXETER V40 MP NECK CEMENTED CSF 8 <1 Yes PINNACLE 8 <1 Yes EXETER V40 SP3 8 <1 Yes CEMENTED GAP2 8 <1 No EXETER V40 EXCEED 8 <1 Yes BICONTACT CEMENTED C- CEMENTED MP NECK CEMENTED B Braun/Aesculap PLASMA 8 <1 No MARATHON 8 <1 No ELITE PLUS CEMENTED 8 <1 Yes KAR ELITE PLUS CEMENTED 7 <1 No REEF ELITE PLUS OGEE 7 <1 No ELITE PLUS PINNACLE 7 <1 No CEMENTED CPT REGENEREX 7 <1 Yes Waldemar Link Waldemar Link MP NECK CEMENTED FURLONG HAC SP II CEMENTED ZMR CEMENTED CONTEMPORARY 7 <1 Yes FURLONG CEMENTED 7 <1 No Waldemar Link SNAP FIT 7 <1 No ZIMMER CEMENTED 7 <1 No KAR Wright Medical UK PROCOTYL 6 <1 Yes National Joint Registry 49

50 Stem manufacturer Stem br Cup manufacturer Cup br Number of MS-30 TRABECULAR METAL EXETER V40 SECURE FIT 6 <1 No 6 <1 No REEF OPERA 6 <1 Yes CHARNLEY CEMENTED OPERA 6 <1 Yes EXETER V40 ULTIMA CEMENTED 6 <1 Yes ECHELON REFLECTION CPT REFLECTION Corin S-ROM CEMENTED TAPERFIT CEMENTED C- AMT CEMENTED SL-PLUS 6 <1 No 6 <1 Yes TRABECULAR METAL 6 <1 Yes OPERA 5 <1 Yes REFLECTION 5 <1 Yes CEMENTED GAP RING 5 <1 Yes EPF-PLUS 5 <1 No CPT PINNACLE 5 <1 Yes C- CEMENTED C- AMT CEMENTED FURLONG CEMENTED BIMETRIC Orthodynamics NOVAE STICK 5 <1 Yes FURLONG CEMENTED FURLONG CEMENTED 5 <1 Yes 5 <1 No STANMORE-ARCOM 5 <1 No MULLER- BIOMET APOLLO 5 <1 No Waldemar Link MP NECK CEMENTED EXCEED 5 <1 Yes MULLER- BIOMET PINNACLE 5 <1 Yes CHARNLEY MODULAR PINNACLE 5 <1 No SOLUTION WROBLEWSKI RESECTION S-ROM ELITE PLUS OGEE 5 <1 No ELITE PLUS OGEE 5 <1 No ELITE PLUS CEMENTED CPT CHARNLEY CEMENTED 5 <1 No 5 <1 Yes 50 National Joint Registry