Development of hip replacement

Development of Hip arthroplasty

Some of the early pioneers in hip replacement development

Gluck - 1891

Robert Jones - Goldfoil - 1895

Rubber femoral head - 1927

Hey-Groves - ivory - 1927

M.N.Smith-Petersen - glass mold - 1923 and metal cup 1938

P.W. Wiles - 1^st total hip - steel 1938

Judet brothers - acrylic cup - 1946

K. McKee & Watson-Farrar - Total hip  - 1951 & 53

Austin Moore , Thompson,etc. - Stemmed arthroplasty 1950

Charnley's thoughts on some of the early ideas:

1951 & 1955 THA was doomed to failure because of problems with the coefficients of friction between metal or metal in bone

1957 continued to advocate his central dislocation compression arthrodesis of the hip

1950 experimented with self-curing acrylic cement

1960 reported on "grout and not cement" in JBJS 1960. Used to interlock the femoral component in place

Charnley observed some of the problems with the early Judet prosthesis such as breakage, wear and squeaking. He realized that one of the major problems was the friction between the two articulating surfaced. Always recognizing the advantages of collaboration in research he began to work closely with mechanical engineers at Manchester University.

Charnley studies on coefficient of friction

Cartilage on cartilage               0.001

Metal on cartilage                     0.05

Metal on bone                          0.5

Metal on metal                         0.5

Following these studies he began looking for a "slippery substance" - a synthetic cartilage. The substance he investigated was PTFE or "Teflon". PTFE has a very low coefficient of friction. It was also the most inert  plastic that was available. In 1956 he began using it in arthroplasty as a synthetic articular cartilage

THE FIRST THREE THA DESIGNS OF CHARNLEY

#1 - original design using of PTFE to cover the head and acetablum

 gave relief of pain and increase in motion however it failed early !!

#2  - Next he used a thicker acetabulum with cup on head. Developed avascular necrosis of the head of the femur

#3 - Next he used the Austin Moore prosthesis (42mm) and Teflon acetabulum

- Results were "gratifying" but not satisfying

Engineer suggested using the smallest head (22mm) to reduce friction and allow a smaller socket

First Publication an Arthroplasty of the Hip on 97 patients

Published in Lancet

May 1961

1962 -- THE ONSET OF TEFLON FAILURES

After 3 - 4 years in 300 patients the Teflon failed - it wore out and he had to replace all of them

"John was sitting in bed with his head in his hands" - Lady Jill

In 1962 he tried other plastics

PTFE with glass ?? In 22 patients - failed

May 1962 was the time for SERENDIPITY

Harry Craven, his engineering assistant, was called by a supply officer V.C. Binns  who was selling a new plastic for gears in heavy equipment - H.M.W.P (High Molecular Weight Polyethylene) from Germany. Craven was excited but Charnley said it was "a waste of time". At that time Charnley went skiing and in his absence Craven put the material on the wear testing machine in the lab. By the time Charnley return from his holiday the results had started to speak for themselves with the new material showing incredibly low wear. So was born the Charnley Low Frictional Torque Arthroplasty (LFA) consisting of a cemented monoblock stem with a 22.225mm head articulating with a HMWP cemented acetabular component.

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