Total hip replacement: a brief history of evolution

The journey to modern hip replacement has been a long and groundbreaking one. People suffering from hip pain date back to human existence, but until recently they had no reliable cure. Fortunately for us, the last century has been filled with orthopedic advancements to help with these life-altering pains.

Today, hip replacement surgery can help relieve pain, help patients return to near-normal function, and improve health-related quality of life1. Total hip replacement surgery has come a long way since its earliest attempts due to new technologies, implant design, and improvements in surgical technique. These include advances in implant material, fixation, bearing surfaces, sizing, minimally invasive tissue conservation approaches, pain management protocols, and technologies such as robotics and computer-assisted surgical devices.

The first recorded attempt at a hip replacement

About 130 years ago, in 1891, the German professor Themistocles Glück made the first recorded attempts at hip replacement surgery. Her motivation was to help her patients with tuberculosis that weakened the body and damaged their hip joints. Glück created an implantable hip prosthesis made of ivory and secured with nickel-plated screws.

A glass test

In 1925, Marius Smith-Petersen, an American physician, tested an implanted glass implant mold. The glass cast implant was a hollow ball that fitted over the femoral head to provide a new smooth surface to improve hip movement. Initially it was successful; however, the glass was unable to hold under the pressures of the joint, causing the patient to break.

Pedal to metal

In 1953, George McKee, an American surgeon, began using a metal-on-metal prosthesis. These were the first surgeries in which both the ball and socket were replaced. The initial success of these implants was quickly overshadowed when metal parts and particles broke due to wear and tear and led to complications.

The father of modern total hip replacement

Sir John Charnley, an orthopedic surgeon at Manchester Royal Infirmary, is considered the father of modern THR. In the late 1950s, Charnley created a prosthesis inspired by the work of dentists by modeling an implant with acrylic bone cement. This cemented hip replacement became popular due to the two main characteristics of cement; its hardness and ability to be used as a grout to improve implant fit.

Charnley's design was a low friction solution that improved patient movement after surgery and solved the squeak heard in other implant solutions at this time. Its design also included a smaller femoral head that reduced implant wear over time, improving the life span and success of the surgery.

Overall, Charnley's contributions laid the foundation for today's modern implant designs and surgical techniques.

From Charnley to now ...

Since Dr. Charnley introduced modern hip replacement, implant designs have improved to offer cementless fixation - or pressure fixation - options, larger femoral head sizes to reduce the risk of dislocation, and improvements in implants. bearing surface materials, particularly highly cross-linked polyethylene which further reduced wear rates.

However, not all improvements come from implant design. Improvements in the surgical approach, from smaller skin incisions to muscle-sparing approaches, have further reduced surgical recovery time and postoperative aesthetics.

Advances in pain management and anesthesia have also allowed for earlier discharge from the facility. Some of the first hip replacements required hospital stays of several months. These have been drastically reduced over time to multi-day stays, and now even to outpatient total hip replacement performed at outpatient surgical centers. Now patients have the option of being admitted and discharged the same day from a hospital or surgical center.

Looking forward...

We are fortunate to live in an age where we can reliably address joint pain without risking broken glass or broken metal on our hips. Thanks to the last 100 years of innovation and current trends, we can confidently address the pains that have caused immobility and severe hip pain in millions of people around the world. We are excited to see what the next 100 years of innovation will bring to the orthopedic industry.