Total Hip Replacement
The History of Total Hip Replacement
Hip replacements have been performed for over 40 years. Their popularity has continued to increase since about 1971. The early designs had a smooth surface and were inserted directly into the bone without the use of bone cement. Those patients frequently experienced some continued pain following insertion. Sir John Charnley from England is credited with the first successful use of bone cement. This firmly fixed the artificial hip to the bone and improved the degree of pain relief.
Since Charnley’s time, millions of artificial hip replacements have been inserted with a 90 percent success rate, offering excellent pain relief with improved function. In this country, over 130,000 artificial hips are implanted every year.
Total hip replacements have undergone several advancements since they were first modified to provide greater durability and improved function. The initial prostheses were inserted with bone cement and experienced a 10 to 15 percent failure rate within 10 to 15 years following insertion due to gradual deterioration and loosening of the bone cement. When the prosthesis loosened patients experienced increasing pain and a revision hip replacement became necessary.
Today, prostheses are designed to be used with or without bone cement. The metal parts of the prosthesis are coated with special surfaces designed to allow bone to grow directly into the metal, thus anchoring the prosthesis and eliminating the need for cement. This type of prosthesis has been used in the United States since the early 1980’s, and the results have been very encouraging.
In certain circumstances, a cemented prosthesis is necessary. Bone cement has been improved and the techniques used to insert it are far better today than in decades past. These improvements in the use of cement have been shown to significantly increase the useful life of the hip replacement. The decision to use cement or not is made by the surgeon and is based on the patient’s age, expected activity level, quality of the bone and the individual’s weight,
The designs and materials of prostheses have continued to change and improve, and will continue to do so. We can safely assume that the average life span of a prosthesis implanted today should be 15 to 20 years or more.
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