Transcript History of Hip Arthroplasty.ppt

Tehran University of Medical Sciences
Orthopedic Department
Prof. Dr. med. R. Safi
Total Hip – Arthroplasty
Evolution
History and Development
Oct. 2011
R.Safi
Total hip-Arthroplasty
Evolution
1925: Smith Petersen in Boston (USA)
molded a piece of Glass in to the shape of
a hollow hemisphere!
1936: scientist manufactured chobalt
cromium. It became clear that pain relief
was not as predictable as
hoped,movement was limited.
Mr.Thompson of New York and AustinMoore of south Carolina separately
developed replacement for the entire ball
of the hip joint, Socket was not replaced.
This type of replacement was called hemi
– arthroplasty. Large number of patients
developed pain.
1938: Jean and Robert Judet of Paris
attempted to use an acrylic Material.
Unfortunately tended to come loose.
1958: Prof.Ring of England developed his Metal
– Metal hip total Prosthesis for Stem and
Socket,which tended also to come loose.
C.M.Evarts reports about early complications of Ring
Total hip Prosthesis, Certain technical problems with the
insertion,infection,dislocation and tromboembolie.
1958: The same problem was occurred with
Mc.Farrer Metal-Metal Prosthesis. It was
performed without Cement-fixation.
1958 – 1959: John Charnley ( 1911 – 1982 )
used Methyl-Metacrilate
( Bone-Cement) to fix an artificial cup made
from Polyethylen!!
It was the true Beginning of:
Total hip Arthroplasty……
Professor Sir John Charnley, FRS, FRCS.
Wroblewski B M Rheumatology 2002;41:824-825
© British Society for Rheumatology
Dr.Gentili ,Radiologist
2002
Canada
--------------------------------------------------------------
Yhzha
2001
Orthopaedic Dep. Hong Kong
---------------------------------------------------Polyethylene wear has been accepted as a major
cause of Osteolysis in THR much Research
works has been done, both in animals and
Patients , the exact mechanism of osteolysis still
remains unclear.
In 1975 Start With noncemented total hip
Replacement , Performed by :
Professor Zweimuller in Vienna
Professor E.Morscher in Basel
Professor Furlong in London
Bone Cement disadvantages:
1234-
Foreign body effect.
Decrease bony vertical movement
Difficulty in revision surgery
Difficulty by implantation and to
achieve correct angle of prosthesis
There are different types of
noncemented total hip prosthesis:
Specification:
Stem: straight stem (grad schaft)
Titanium
Prepared with Porous – coated or
hydroxie apatite
Head : chrom cobalt surface
Different size of neck
The usual type of non cemented Total hip :
1- Stem: Titanium + Polyethylen – cup +
Metal head (Crom Cobalt)
2- Stem: Titanium + Ceramic head +
Polyethylen cup
3- Stem: Titanium + Ceramic head +
Ceramic cup
4- Stem: Titanium + Head and cup metalic
(Weber Prosthesis).
Conclusion
The non cemented total hip replacement
Is preferred to implant in:
1- Younger patients.
2- Survival time aprox. More than 10 years
3- Should have a good cortical Bone –
substance.
4- In Revision Arthroplasty.
Thank you for your attention