History of the Total Hip Replacement

The first surgery used in the treatment of hip arthritis was the complete removal (surgical excision) of the hip joint. This was problematic for many reasons, including inability to perform activities requiring movement of the lower body.

The earliest attempt at replacing the diseased hip occurred in the 1890’s, when a surgeon replaced a worn acetabulum (socket) with a prosthetic made from the ivory tusk of an elephant. In the years to follow, surgeons pioneered various operations, including placing materials made of different human and animal tissues between the head of the femur and acetabulum to decrease friction between the joint surfaces (interpositional hip arthroplasty).

Another notable advance in hip replacement technology took place in 1925. A surgeon invented a hollow hemisphere made of glass that could fit over the head of the femur, creating a smooth surface over which the hip bones can glide. Although this was an improvement over some of the other materials used to replace the articulating surface of the hip joint, the glass was not strong enough to withstand the forces placed on it during hip movement.

Sir John Charnely develops the modern hip replacement

The modern hip replacement as we know it today was developed by Sir John Charnley. Charnley was a British orthopaedic surgeon who designed and experimented with a unique hip replacement beginning in the 1950’s. His design involved a femoral prosthesis that was cemented into the thigh bone with special bone cement, and a prosthesis for the hip socket (acetabulum). The interface between the femoral and acetabular prosthesis was intended to be “low friction.” Charnley initially aimed to achieve this by using a Teflon surface for the acetabular component. However, in the late 1950’s when he inserted this “Teflon” type of prosthesis into patients, they almost all failed fairly quickly due to an intense inflammatory reaction. As a result, they needed to be revised surgically within a few months to a few years. Despite this major setback, Charnley persisted and decided to use polyethylene as the bearing surface in the hip socket rather than Teflon. The use of polyethylene as a bearing surface worked much better and during the 1960’s Charnley worked to perfect his “low friction hip replacement” by determining ways to minimize the complications of infection and blood clots while continuing to improve the functioning of the joint replacement. These early Charnley hip replacements served as the prototypes of the present hip replacements that are used today (figure 1).

Figure 1: X-ray of a total hip replacement (arthroplasty)

Charnley’s hip replacements became so effective that hip replacements he performed in the early 1970’s prior to his retirement are often considered the most successful hip replacements ever performed, with most of them lasting more than 20 years. Charnley’s breakthrough led to more consistent and favorable outcomes following total hip replacements and marked a turning point in the care of individuals affected by degenerative diseases of the hip.