History of Hip Surface Replacement Arthroplasty 2 - Callum Clark 26/4/2001

Evolution of THR since 1930s;

Head-replacing vs. Surface-replacing

Metal-on-metal vs. Metal-on-poly (and ceramic)

Cemented vs. Cementless

2 Facets of evolution of present-day metal-on-metal S.R.A.;

1/ Metal-metal bearing hips

2/ Surface Replacement prostheses

METAL-ON-METAL BEARING TOTAL HIP REPLACEMENTS

1938     Philip Wiles , Middx Hospital. "Thrust-plate" type THR in 6 young pts.

            Lasted few years

1950        Kenneth McKee (was Wiles' SR), N+N Hospital. 1 ^st 3 cases- 2 loose in 1 year (stainless steel).

Visited USA - saw Thompson prosthesis made changes along same lines (Co-Cr-Mo). Uncemented.

Late 1950s, put in 26- 15 lasted 7 yrs, others failed early

1960        Charnley introduced bone cement.

McKee changed to cemented cup, but hemispherical shape and wide neck meant impingement.

1966        McKee-Farrar hip had narrower neck, then smaller cup (better cover), then head slightly smaller than cup - "polar" bearing, not "equatorial"

(Hugh Philips revised a lot of these, and at 20 yrs, found some had metallic staining only)

(Technique then was no reaming, one size fits all, and no anteversion of cup)

1964        Peter Ring (Redhill, Surrey) - Ring prosthesis = Austin Moore + screw-in metal cup.

             Early results were 38% poor. Increased valgus and bigger screw gave 80% survivorship @ 17 yrs

(Discontinued 1979).

1963        John Scales (RNOH) "Stanmore metal-on-metal" - poorly machined, equatorial bearing.

High incidence of loosening and "seizing up".

1968, made polar and better finishing - 15% failure @ 11 yrs.

1964        Maurice Muller (St. Gallen, Switzerland) - initially cemented, then cementless in young patients.