Hip replacement surgery is
without doubt one of the most
important surgical advances
of the last century and has
helped ease the suffering and
disability of countless people
throughout the world.
Rudimentary efforts have been documented throughout the history of hip
replacement surgery from
as early as the17th century. Among the more daring were the experimental
uses of materials implemented such as: celluloid, silver plates, rubber struts,
magnesium, zinc, glass, pyres, de calcified bones, wax, muscle tissue and
celluloid. Of course, there were no long term success stories achieved whilst
experimenting with these materials as the body almost always reacted against
them. These materials were also unable to cope with the stress of supporting
body weight for long periods of time. These early experimental days did
however start paving the way for surgeons’ successful attempts at hip
replacement surgery. Throughout the early days of prosthesis surgery, most
operations were performed to replace only one of the joints and through the
experimental years there was also risk of infection that was inherent before the
advent of antibiotics.
The use of artificial hips were slowly becoming better known within medical circles by the 1930s, though
it was still rare for someone to undergo hip replacement surgery throughout this
There were also experimental attempts to replace joints with Teflon, which
seemed like a good idea at the time, but the Teflon prosthesis itself normally wore
out within two to three years, or eventually caused patients to suffer osteolysis,
which is where the bone starts to dissolve and be reabsorbed by the body. Even
though these first hip replacement surgeries seemed rudimentary, they were
considered to be a better alternative than the crippling and severe pain that was
endured by people suffering arthritis. One of the major problems with the
experimental materials was that the articulating surfaces inserted in the joints were
unable to be naturally lubricated by the body which made them to wear each other
down and eventually loosen; making it necessary to replace the joints again by
performing revision surgery. Artificial joints were eventually being manufactured from steel or chrome which had
a much better ‘hip life’ due to the materials superior strength non corrosive quality.
Orthopaedic surgery owes a great deal of its
development to its role in military conflicts that
occurred throughout the first
half of the century...
Advancements and the minds behind them......
Dr. McKee. By the early 1950s, a British orthopaedic surgeon, Dr. McKee had
designed a prosthesis on the femoral side that articulated with a three claw type cup that
was screwed into the acetabulum (the surface of the joint that the ball joint fits into). The
initial high incidences of failure resulted from the loosening of components, as there was no
adequate holding cement available to keep the prosthesis in place for long periods of time.
It was throughout the 1960s that Hip replacement surgery became more widespread
and available to patients. At the XIX World Congress of Surgery/International College of
Surgeons (1974) Dr. McKee presented results from the first 300 total hip prosthesis and
concluded that the most important principle was to obtain the firm fixation of components in
the bone using screws, then later using acrylic cement.
Dr. San Baw
In 1960 a Burmese orthopaedic surgeon, Dr. San Baw who was chief of the
orthopaedic surgery unit at the Mandalay General Hospital in Burma pioneered the use
of ivory hip prostheses to replace united fractures of the neck of the femur. Dr. San Baw
at first bravely used an ivory prosthesis to replace the fractured hip bone of an 83 year
old Burmese Buddhist nun. He continued his work up until the 1980s’ with considerable
success and is now famous for it.
Dr. Peter Ring, from Surrey, England started his clinical experience
with cement- less components with a metal-on-metal articulation in 1964. Some of his
early Arthroplasty surgery provided surprisingly good results with up to 97% of
implants surviving years of follow up.
Sir John Charnley
The modern artificial joint owes much to the work of Professor John Charnley
from the Manchester Royal Infirmary. Dr. Charnleys’ work throughout the 1970s’ in the
field of tribology resulted in a design that completely replaced previous designs prior to
the 1970s. Charnley's design consisted of three parts which were: a stainless steel
metal femoral component (the ball attached to the femur) which connected to an Ultra
high molecular weight polyethylene acetabular component. Both of these prosthesis
were fixed to the bone using the third and last element; a specially manufactured bone
cement. The replacement joint was known as the Low Friction Arthroplasty and was
lubricated with synovial fluid. The small femoral head on occasion produced wear and
tear problems which made it suitable only for much older patients with less mobility,
however there was a huge reduction in resulting friction which led to excellent clinical
results. For over two decades, the ‘Charnley Low Friction Arthroplasty’ design was the
most used system in the world, far surpassing other available options created by McKee
and Ring, though all three men had contributed to the successful hip replacement
surgery by this time.
Dr Charnley was eventually knighted by the Queen for his innovation and efforts
within prosthesis surgery that helped thousands of patients throughout the world.
Since then improvements in joint replacement surgery, techniques and the
technology used have increased the effectiveness of total hip replacement, though it still
remains to this day an invasive and aggressive surgical procedure. The greatest advances
have been implemented by surgeons themselves, which is not surprising as these are the
men responsible for carrying out and overseeing the surgery, which gave them the insight to create new ideas
Modern day Prosthesis operations
Throughout the last decade, several evolutionary developments have been created
within total hip replacement procedures and prosthesis. Many hip implants are made of
a ceramic material rather than polyethylene, which some research indicates dramatically
reduces joint wear. Metal-on-metal implants are also gaining popularity. However several
Orthopaedic manufacturers have now removed this type of hip prosthesis due to the
many complications these prosthesis create such as metal corrosion and the infiltration
of metal particles within the body.
Most implants are now joined without cement; the prosthesis is given a porous
texture into which bone grows. However this method is still deemed to be invasive.
Hip Resurfacing Surgery...
Hip resurfacing is generally used as an alternative to total hip replacement and is
often suggested for active patients under the age of 55.
Hip replacement surgery was adapted in the 1970s’ and came with some success,
but surgeons preferred to opt for hip replacement surgery because of the early
complications that resurfacing surgery was causing. Improvements over the last two
decades have made hip resurfacing surgery more attractive and can now be a better
option for some patients, especially younger and active people.
Hip resurfacing surgery is very different from hip replacement surgery because the
femur head is reshaped and then resurfaced with a metallic shell. A metal socket is then
inserted into the pelvis to support the newly resurfaced femur joint. This surgical
procedure reduces pain and ensures better joint stability. The chance of dislocation also lowers if resurfacing
surgery is performed rather than with a total hip replacement. Revision surgery from resurfacing the hip bones is
also not as complicated and less healthy bone is lost through this type of surgery.
A Brief History of Prosthesis
1950s Dr. McKee
designs a prosthesis
on the femoral side
that articulates with
a three claw cup
that screwed into
1960. Dr. San Baw
at the Mandalay
General Hospital in
Burma pioneers the
use of ivory hip
fractures of the neck of the
1964 Dr. Peter
starts a clinical
trial with cement-
with a metal-on-
97% of implants survived the
years of follow up.
1970s’ Sir John
designs prior to
consisted of three
parts which connected to an
Ultra high molecular weight
polyethylene ace tabular
With 35 years of expertise in
orthopaedics, Dr. Javier
Cabrera patents the Bio Total
Hip, a medical invention which
is set to revolutionise Hip
replacement surgery and its
The process of manufacturing
prosthesis parts requires large amounts
of energy which add onto more
unwanted environmental pollution.
New York, March 2012 a team of 35
government manufacturers and
doctors hold a summit about arthritis.
Among other conclusions they discuss
the Inadequacy of arthritic
classification, the need for new
treatments associated to the
symptoms in bone cartilage and joint
structural abnormalities in the stages
of disease. There are concerns in the
scientific world about the treatment
for arthrosis and the economical
consequences of Arthroplasty surgery
with its environmental issues.
Dr. Javier M. Cabrera
Today, more than 193,000 total hip replacements are performed each year
in the United States alone. Similar surgical procedures on other damaged
joints are performed including knees, shoulders, and elbows being the most
common joints in need of repair.
March 1974. The XIX World Congress of Surgery,
Members from the International College of
Surgeons including the worlds most renowned
orthopaedic surgeons from England, Europe and Australia
gathered. Leading surgeons from the congress were
asked to present their feedback on hip prosthesis surgery.
Dr. Javier M. Cabrera LMS.FICS. reported success in
orchestrating and implanting the first cemented total hip
prosthesis within private hospitals. From this time
onwards the FDA approved and granted the use of acrylic
cement for prosthesis surgery throughout the US.
Since the 1974 congress millions of patients
throughout the world have been treated with cemented
total hip prosthesis within Private Hospitals.
X ray of the first cemented
THP (McKee type )
performed by Dr. Cabrera in
a Private Hospital.
Bio Total Hip ® www.biototalhip.com