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


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.

Did 35 stemmed and 18 surface replacement, then changed to poly cup. 6 were revised @ 25 yrs - NO macroscopic wear!

Other metal-on-metal replacements in 1950s and 60s in USA and France , most were

            Either Moore or Thompson stems with metal cup: e.g.  Merle D'Aubigne,

            McBride, Gaenslen, Urist.

1970s  METAL ON METAL WAS ABANDONED in favour of Charnley THR

  Reasons:       1 -  Better early results with Charnley

                           2 - Frictional torque greater with metal-metal, increased shear across implant-

                           bone interface - ?increased loosening. Also caused "seizing"

                           3 - Carcinogenesis concerns

                           4 - Metal sensitivity concerns

                           5 - ?High infection rates

1984        Muller, Weber (Sulzer) re-introduced idea of metal-on-metal

BUT effectively 30 yrs of research into how to improve metal-poly prostheses.

Noticed some metal-metal implants have survived 20 yrs†¦

1991        McMinn prosthesis.


Early pioneers Smith-Peterson and Anfranc (10-20% early revision rates)

1950s  Charnley resurfacing prosthesis made of Teflon - disaster with early failures

1953        Haboush - cemented metal-metal

1960        Townley  -  used polyurethane with bad results

1967        Muller - cementless metal-metal

1974        Gerard - cementless metal-metal

1970s  Various metal-poly resurfacing implants:

            Trentani 1971

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