TOTAL HIP REPLACEMENT: A BRIEF HISTORY

IVORY AND GLASS HIP REPLACEMENT

The modern era of Total Hip Replacement began in the 1960’s, however you might be surprised to learn that the first attempts at hip replacement began in the 1890’s in Germany. In this operation ivory was used to replace the femoral head in patients with Tuberculosis.

During the 1920’s moulded glass was used as a bearing surface, but not surprisingly, this device failed due to the brittleness of the device.

METAL ON METAL HIP REPLACEMENTS

In the 1950’s surgeons from England made a total hip replacement which looks more like the modern day implant. This was invented by George McKee and was a metal on metal bearing surface. The survival rate for this total hip replacement was much better than its predecessors and encouraged the growth of the technology.

Around the same time, French surgeons were experimenting with acrylic femoral head replacements. These devices did not last well in the bone and loosened early.

MODERN ERA OF HIP REPLACEMENT

The modern era of total hip replacement began in the 1960’s when English surgeon Sir John Charnley developed his “Low friction arthroplasty” which consisted of a metal femoral stem and a polyethylene acetabular cup which were seated in the bone using acrylic bone cement. The success of this implant established a gold standard in hip replacement by which newer devices are judged.

Interested surgeons from all over the world visited Charnley’s hospital in Wrightington, England and brought the knowhow home with them. Surgeons in Australia imported his techniques and began hip replacement surgeries in Sydney in the early 1970’s. Since then countless numbers of patients have benefitted from the steady progression of technology, surgical technique and pain management.

TECHNOLOGY DELIVERS BETTER OUTCOMES

The progression of technology has focused on two main areas. The most important is the development of durable bearing surfaces. In Charnley’s total hip replacement, the wear particles generated could cause failure of the device within 10-15 years, especially in younger patients. These days improved biomaterials such as advanced ceramics, cross linked ultra-high molecular weight polyethylene (UHMWPE) can deliver a hip replacement that will last for decades.

The other area of technological development is the removal of cement from the construct. Today many modern hip replacements are placed in the bone without cement. The surrounding bone grows onto the complex roughened implant surfaces to secure the implant for decades. This not only saves time during surgery, but also reduces the rare risk of an allergic type response to the bone cement. 

Ceramic and polyethylene options with uncemented cup.

HIP REPLACEMENT TODAY

Total Hip replacement is now a durable, safe and cost effective procedure which restores mobility and function for patients as young as twenty or as old as ninety.