History of THA Luke Gauthier January 6, 2011

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

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

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

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

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

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

Ring MoM large dia. head screw fixation for cup

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

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

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

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

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

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

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

Results Modern (THA) Cemented Uncemented MoP MoP MoM CoC 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

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

What’s Going on Elsewhere

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