1. History of THA
Luke Gauthier
January 6, 2011

2. 1800s amputation 1st joint excision excision + pseudarthrosis
fast (no anesthetic)
easy
1st joint excision
Anthony White 1821 Westminster London
excision + pseudarthrosis
John Rhea Barton Philadelphia
resect + move limb to prevent bony union (early ROM!!)
intertrochanteric osteotomy (7 minutes)
mortality rate ~50%
****pic ship and hook hand

3. late 1800s 1860 Verneuil 1891 Gluck soft tissue interpositions
fascia lata, pigs bladder, gold strips
1891 Gluck
ivory ball and socket with primitive cement
screws

4. 1920’s 1924- New York City, Whitman,
The Hospital for Ruptured and Crippled (now HSS) - resection arthroplasty
1923- Boston: Marius Smith-Petersen
synthetic mold arthroplasty
allows motion on both femoral and acetabular side, body to wall off smooth surface
“would guide natures repair”
probably done by an anterior approach 4

5. Total Hip Arthroplasty
1930s - Wiles 1st THA w/ stainless steel
Haboush – bone cement

6. - Gathorne Robert Girdlestone, 1940
Judet – acrylic
++wear
Frederick Röeck Thompson- 1) Vitallium® (cobalt chrome) )intramedullary stem
Thompson-Moore
1940 Moore
Smith-Petersen

7. McKee-Farrar Thompson stem cobalt chrome MoM cemented stem
cup screwed in

8. Ring
MoM
large dia. head
screw fixation for cup

9. Charnley= Modern arthroplasty “Low Friction Arthroplasty” CLFA
looking for self lubrication, low friction
Teflon on Teflon (low coefficient of friction but non wettable)
failed within 2 yrs
MoM = high frictional torque
predicted to loosen components-> low frictional torque arthroplasty
polytetrafluroethylene
PTFE
modern low friction arthroplasty 1960’s

10. MoM = high frictional torque
predicted to loosen components-> low frictional torque arthroplasty
metal on Teflon
osteolysis and teflon wear
higher osteolysis with larger heads (22mm chosen)

11. 11

12. 1962 Charnley low frictional torque arthroplasty (LFA)
cemented HMWPE cup (1966)
cemented femoral stem (thompson stem)
22.225mm femoral head
trochanteric osteotomy
restricted to elderly or “young crippled”
Earlier press fit attempt
methylmethacrylate
PMMA
polyethylene

13. Results ‘Spectacular’
2500 LFA’s --> 1st component 6 years
‘Charnley Gold Standard’
*1979 (12-15 yr results) only 77 of first could be reviewed 13

14. 1970s
3 common arthroplasties (all British)
Charnley
McKee-Farrar
Ring

15. Results (survival) Charnley McKee Ring 70% at 31 yrs (all)
85% at 20 yrs (living)
77% at 25 yrs (living)
68% at 30 yrs (living)
53% at 35 yrs (living)
McKee
84% at 20 yrs
74% at 28yrs
153 joints, 5 infections, 14 aseptic loosening
Ring
5% revision at 17yrs
Actually all did pretty well long term, but Charnley method had been adopted by others

16. Cementless (cup, femur)
refine cemented
stem design, cement technique
Cementless (cup, femur)
bony ingrowth vs. cement mantle
surface coatings 1980’s
Improved manufacturing
Increasing head size
Ceramic bearings
Metal on Metal
differential hardness
Increased modularity
Back to Resurfacing
Exeter 1970
wrought,
harder
cast,
softer

17. Results Modern (THA) Cemented Uncemented MoP MoP MoM CoC
18yr 89% Espehaug Acta Orthop (Norwegian Register)
Uncemented
MoP
10yr 91.3% D’Antonio JBJS 2009
20yr cup 86%/stem 98% AML Belmont (Engh) JBJS 2008
MoM
10yr 98% stem 96% cup (Lubrimet, Neumann J Arthoplasty 2009)
CoC
10yr 96.6% D’Antonio JBJS 2009

20. cement?
*however these were 1st generation cementless, poor locking mechanisms,poly

21. What’s Going on Elsewhere

22. Summary
Charnley multiple contributions which constitute era of modern arthroplasty
Success to build on
Older concepts now examined in different light
Acknowledgements: Will McCormick previous talk 22