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History of THA Luke Gauthier January 6, 2011. 1800s amputation –fast (no anesthetic) –easy 1st joint excision –Anthony White 1821 Westminster London excision.

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Presentation on theme: "History of THA Luke Gauthier January 6, 2011. 1800s amputation –fast (no anesthetic) –easy 1st joint excision –Anthony White 1821 Westminster London excision."— Presentation transcript:

1 History of THA Luke Gauthier January 6, 2011

2 1800s amputation –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)

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

4 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 Judet – acrylic –++wear Frederick Röeck Thompson- 1) Vitallium® (cobalt chrome) + 2)intramedullary stem Thompson-Moore –1940 Moore - Gathorne Robert Girdlestone, 1940 Smith-Petersen

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

8 Ring

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

10 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)

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

13 13 Results ‘Spectacular’ 2500 LFA’s --> 1st component 6 years ‘Charnley Gold Standard’ *1979 (12-15 yr results) only 77 of first 500 could be reviewed 13

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

15 Results (survival) Charnley –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

16 16 cast, softer wrought, harder –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

17 Results Modern (THA) Cemented MoP –18yr 89% Espehaug Acta Orthop 2009 (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

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

21 What’s Going on Elsewhere

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


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