History of Total Hip Replacement Surgery

The earliest recorded attempts at hip replacement (Gluck T, 1891), which were carried out in Germany, used ivory to replace the femoral head.

In 1940, at Johns Hopkins hospital, Dr. Austin T. Moore (1899-1963), an American surgeon, reported and performed the first metallic hip replacement surgery. The original prosthesis he designed was a proximal femoral replacement, with a large fixed head, made of the Cobalt-Chrome alloy Vitallium. It was about a foot in length and it bolted to the resected end of the femoral shaft (hemi-athroplasty). This was unlike later (and current) hip replacement prostheses which are inserted within the medullary canal of the femur. A later version of Dr. Moore's prosthesis, the so-called 'Austin Moore', introduced in 1952 is still in use today.

In 1960 a Burmese orthopaedic surgeon, Dr. San Baw pioneered the use of ivory hip prostheses to replace ununited fractures of the neck of femur ("hip bones"), when he first used an ivory prosthesis to replace the fractured hip bone of an 83 year old Burmese Buddhist nun, Day Punya. This was done while Dr. San Baw was the chief of orthopaedic surgery at Mandalay General Hospital in Mandalay, Burma. Dr. San Baw used over 300 ivory hip replacements from the 1960s to 1980s. He presented a paper entitled "Ivory hip replacements for ununited fractures of the neck of femur" at the conference of the British Orthopedic Association held in London in September 1969. An 88% success rate was discerned in that Dr. San Baw's patients ranging from the ages of 24 to 87 were able to walk, squat, ride a bicycle and play football a few weeks after their fractured hip bones were replaced with ivory prostheses. Ivory may have been used because it was cheaper than metal at that time in Burma and also was thought to have good biomechanical properties including "biological bonding" of ivory with the human tissues nearby. An extract from Dr San Baw's paper, which he presented at the British Orthopedic Association's Conference in 1969, is published in Journal of Bone and Joint Surgery (British edition), February 1970. With modern hip replacement surgery, one can expect to walk, using crutches for support or even just a cane for balance, within a week.

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Modern process

The modern artificial joint owes much to the work of John Charnley at Wrightington Hospital; his work in the field of tribology resulted in a design that almost completely replaced the other designs by the 1970s. Charnley's design consisted of three parts—

a metal (originally stainless steel) femoral component,
a teflon acetabular component, the wear debris of which resulted in a condition called Osteolysis, and so it was replaced by Ultra High Molecular Weight Polyethylene or UHMWPE in 1962, both of which were fixed to the bone using
PMMA (acrylic) bone cement, and/or screws.

The replacement joint, which was known as the Low Friction Arthroplasty, was lubricated with synovial fluid. The small femoral head (7/8" (22.2 mm)) was chosen for its decreased wear rate; however, this has relatively poor stability (the larger the head of a replacement the less likely it is to dislocate, but the more wear debris produced due to the increased surface area). For over two decades, the Charnley Low Friction Arthroplasty, and subsequent similar designs were the most used systems in the world, far surpassing the other available options (like McKee and Ring). Recently the use of a polished tapered cemented hip replacement (like Exeter) and uncemented hip replacements have become more popular. Cemented stems are commonly used in older patients due to their lower cost, including the Austin Moore proximal femoral replacement for Medicaid patients, while more modern and longer lasting 'cementless' stems, often coated in Hydroxy-Apatite Ceramic, are used in 'younger' and more physically active patients. Once an uncommon operation, hip replacement is now common, even among active athletes including racecar drivers Bobby Labonte and Dale Jarrett.