The Exeter Contemporary flanged cemented acetabular component in primary total hip arthroplasty

Aims: We report on the outcome of the Exeter Contemporary flanged cemented all-polyethylene acetabular component with a mean follow-up of 12 years (10 to 13.9). This study reviewed 203 hips in 194 patients. 129 hips in 122 patients are still in situ; 66 hips in 64 patients were in patients who died before ten years, and eight hips (eight patients) were revised. Clinical outcome scores were available for 108 hips (104 patients) and radiographs for 103 hips (100 patients). Patients and Methods: A retrospective review was undertaken of a consecutive series of 203 routine primary cemented total hip arthroplasties (THA) in 194 patients. Results: There were no acetabular component revisions for aseptic loosening. Acetabular revision was undertaken in eight hips. In four hips revision was necessitated by periprosthetic femoral fractures, in two hips by recurrent dislocation, in one hip for infection and in one hip for unexplained ongoing pain. Oxford and Harris hip scores demonstrated significant clinical improvement (all p < 0.001). Radiolucent lines were present in 37 (36%) of the 103 acetabular components available for radiological evaluation. In 27 of these, the line was confined to zone 1. No component had migrated. Conclusion: Kaplan–Meier survivorship, with revision for aseptic loosening as the endpoint, was 100% at 12.5 years and for all causes was 97.8% (95% confidence interval 95.6 to 100) when 40 components remained at risk. The Exeter Contemporary flanged cemented acetabular component demonstrates excellent survivorship at 12.5 years. Take home message: The Exeter Contemporary flanged cemented acetabular component has excellent clinical outcomes and survivorship when used with the Exeter stem in total hip arthroplasty.

Dancing into the second phase of creative industries

As we enter the second phase of creative industries there is a shift away from the early 1990s ideology of the arts as a creative content provider for the wealth generating ‘knowledge’ economy to an expanded rhetoric encompassing ‘cultural capital’ and its symbolic value. A renewed focus on culture is examined through a regional scan of creative industries in which social engineering of the arts occurs through policy imperatives driven by ‘profit oriented conceptualisations of culture’ (Hornidge 2011, p. 263) In the push for artists to become ‘culturpreneurs’ a trend has emerged where demand for ‘embedded creatives’ (Cunningham 2013) sees an exodus from arts-based employment through use of transferable skills into areas outside the arts. For those that stay, within the performing arts in particular, employment remains project-based, sporadic, underpaid, self-initiated and often self-financed, requiring adaptive career paths. Artist entrepreneurs must balance creation and performance of their art with increasing amounts of time spent on branding, compliance, fundraising and the logistical and commercial requirements of operating in a CI paradigm. The artists’ key challenge thus becomes one of aligning core creative and aesthetic values with market and business considerations. There is also the perceived threat posed by the ‘prosumer’ phenomenon (Bruns 2008), in which digital on-line products are created and produced by those formerly seen as consumers of art or audiences for art. Despite negative aspects to this scenario, a recent study (Steiner & Schneider 2013) reveals that artists are happier and more satisfied than other workers within and outside the creative industries. A lively hybridisation of creative practice is occurring through mobile and interactive technologies with dynamic connections to social media. Continued growth in arts festivals attracts participation in international and transdisciplinary collaborations, whilst cross-sectoral partnerships provide artists with opportunities beyond a socio-cultural setting into business, health, science and education. This is occurring alongside a renewed engagement with place through the rise of cultural precincts in ‘creative cities’ (Florida 2008, Landry 2000), providing revitalised spaces for artists to gather and work. Finally, a reconsideration of the specialist attributes and transferable skills that artists bring to the creative industries suggests ways to dance through both the challenges and opportunities occasioned by the current complexities of arts’ practices.