Hip Pelvis.  2019 Dec;31(4):179-189. 10.5371/hp.2019.31.4.179.

Total Hip Arthroplasty: Past, Present, and Future. What Has Been Achieved?

Affiliations
  • 1Department of Orthopedic Surgery, Bumin Hospital, Busan, Korea.
  • 2Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea. 3188yun@naver.com

Abstract

In the 1960s, Sir John Charnley introduced to clinical practice his concept of low-friction total hip arthroplasty (THA). Although early designs were plagued by poor performance and even failure, there have been steady advances in implant designs, biomaterials, surgical techniques and an understanding of the biomechanical restoration of the hip; these advances have contributed to improvements in implant survival and clinical outcomes of THA in the past three decades. With improved wear resistance and mechanical reliability, a potential to last for at least 25 to 30 years are now available for THA. In this review, we focus on the evolution of THA and review current controversies and future directions of this procedure based on a single surgeon's 29-year of experience at a single institution.

Keyword

Total hip arthroplasty; Acetabular cup; Femoral stem; Bearing surface; Impingement

MeSH Terms

Arthroplasty, Replacement, Hip*
Biocompatible Materials
Hip
Biocompatible Materials

Figure

  • Fig. 1 Various cemented femoral stems. The Precoat Plus stem is located in the most left-hand corner of the image.

  • Fig. 2 (A–D) Radiograph and computed tomography images 12-year post hybrid total hip arthroplasty in a 47-year-old male patient revealing excessive wear and pelvic lysis.

  • Fig. 3 Computed tomography image and anteroposterior hip radiography 24-years post hybrid total hip arthroplasty in a 55-year-old male patient revealing excessive polyethylene liner wear and periacetabular lysis in the left hip joint.

  • Fig. 4 (A–E) Postoperative radiographic images. Arrows show distal cement mantle defects with osteolysis.

  • Fig. 5 Anteroposterior hip radiography 27-year post hybrid total hip arthroplasty in a 48-year-old female patient revealing excellent radiological results.

  • Fig. 6 Lysis free rate with time.

  • Fig. 7 A screenshot revealing osteolysis volume measurement on computed tomography using Rapidia 2.8 software.

  • Fig. 8 Anteroposterior hip radiography 17-year post bilateral hybrid total hip arthroplasty in a 50-year-old male patient revealing excellent radiological results.

  • Fig. 9 (A–F) Retrieved polyethylene liners revealing rim damage extending across the entire rim.

  • Fig. 10 Anteroposterior hip radiography 4-year post ceramic-on-metal bearing total hip arthroplasty in a 51-year old male patient revealing excellent radiological results.

  • Fig. 11 (A, B) Retrieved acetabular and femoral components from a 43-year-old male patient revealing polyethylene liner damage by impingement between the rim of polyethylene liner and neck of the femoral stem.

  • Fig. 12 Hip anteroposterior radiographs (A, B) and a clinical photo (C) of a 32-year-old male patient revealing polyethylene liner wear and damages by impingement.


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