Charnley, Clin Orthop Relat Res 1970 - Total Hip Replacement by Low-Friction Arthroplasty

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Total Hip Replacement by Low-Friction Arthroplasty

Charnley·Clin Orthop Relat Res·1970·384 citations·Retrospective cohort

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Charnley tested whether low-friction arthroplasty, a 22 mm cobalt-chrome head on a cemented high-density polyethylene (HDP) socket with lever-arm reconstruction, gives durable pain relief and low mechanical failure. Clinical and radiographic case series of 138 hips followed 5 to 7 years, graded by D'Aubigné-Postel pain score and radiographic socket wear.

Key Findings

Pain (D'Aubigné-Postel, 138 hips): severe or spontaneous pain fell from 97.6% preoperatively to no or slight pain in 96.4% at 5 years.
HDP socket wear at 5 years, measured against an embedded reference wire:
- Maximum wear: about 1 mm
- No detectable wear: more than 50%
Mechanical failure was rare. Socket loosening occurred in 2 of 138 hips. Dislocation occurred in about 1 in 300 operations.
Trochanteric lateralization, acetabular deepening and correction of external rotation brought the lever ratio near 1:1 (normal about 1:2.5), lowering joint reaction force to about 2 times body weight.
Significance: Charnley showed that a small-diameter metal head on a cemented polyethylene socket, combined with biomechanical reconstruction, relieved pain reliably with low wear and low loosening at medium-term follow-up, a design now known as the Charnley low-friction arthroplasty.

Board PearlCharnley chose a 22 mm head because volumetric wear depends on sliding distance, which rises with head diameter, more than on surface stress.

Total Hip Replacement by Low-Friction Arthroplasty.

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Total Hip Replacement by Low-Friction Arthroplasty

Charnley·Clin Orthop Relat Res·1970·384 citations·Retrospective cohort

|

Charnley tested whether low-friction arthroplasty, a 22 mm cobalt-chrome head on a cemented high-density polyethylene (HDP) socket with lever-arm reconstruction, gives durable pain relief and low mechanical failure. Clinical and radiographic case series of 138 hips followed 5 to 7 years, graded by D'Aubigné-Postel pain score and radiographic socket wear.

Key Findings

Pain (D'Aubigné-Postel, 138 hips): severe or spontaneous pain fell from 97.6% preoperatively to no or slight pain in 96.4% at 5 years.
HDP socket wear at 5 years, measured against an embedded reference wire:
- Maximum wear: about 1 mm
- No detectable wear: more than 50%
Mechanical failure was rare. Socket loosening occurred in 2 of 138 hips. Dislocation occurred in about 1 in 300 operations.
Trochanteric lateralization, acetabular deepening and correction of external rotation brought the lever ratio near 1:1 (normal about 1:2.5), lowering joint reaction force to about 2 times body weight.
Significance: Charnley showed that a small-diameter metal head on a cemented polyethylene socket, combined with biomechanical reconstruction, relieved pain reliably with low wear and low loosening at medium-term follow-up, a design now known as the Charnley low-friction arthroplasty.

Board PearlCharnley chose a 22 mm head because volumetric wear depends on sliding distance, which rises with head diameter, more than on surface stress.

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