This 2007 Lancet review by Learmonth traces the full evolution of total hip replacement from Charnley's original low friction arthroplasty through modern bearing surfaces, fixation strategies, conservative implants, and minimally invasive techniques. The central question: what principles and technologies best deliver durable, high-performance hips for an increasingly young and active patient population? Registry data from Sweden, Norway, and Australia anchor the survivorship comparisons.
For years, the failure of early cemented THR was attributed to 'cement disease' — PMMA particles triggering osteolysis. This review clarifies the real culprit is polyethylene debris, and that early failures reflected poor cementation technique rather than an inherent flaw in cement as a fixation strategy.
When counseling a patient under 50 about fixation strategy, the 44% cemented cup loosening rate at 12 years is the number to anchor the conversation. Cementless acetabular fixation is strongly supported in this age group. The femoral side is a different story: modern cemented tapered stems (Exeter, C-stem) achieve up to 100% survivorship at 7–10 years, and the authors argue cement remains a legitimate first choice for femoral fixation in most patients.
When a young patient asks about hip resurfacing, cite the 1.46% femoral neck fracture rate from 3497 Australian hips. Varus placement and neck notching are the avoidable technical errors. The authors' warning that early enthusiasm outpaced the evidence presaged the subsequent decline of resurfacing after metal-ion concerns emerged in the early 2010s.
The global preference for cementless implants. Documented here as not evidence-based. Is a testable board concept and a reminder that surgical fashion does not always follow data.
This 2007 Lancet review by Learmonth traces the full evolution of total hip replacement from Charnley's original low friction arthroplasty through modern bearing surfaces, fixation strategies, conservative implants, and minimally invasive techniques. The central question: what principles and technologies best deliver durable, high-performance hips for an increasingly young and active patient population? Registry data from Sweden, Norway, and Australia anchor the survivorship comparisons.
For years, the failure of early cemented THR was attributed to 'cement disease' — PMMA particles triggering osteolysis. This review clarifies the real culprit is polyethylene debris, and that early failures reflected poor cementation technique rather than an inherent flaw in cement as a fixation strategy.
When counseling a patient under 50 about fixation strategy, the 44% cemented cup loosening rate at 12 years is the number to anchor the conversation. Cementless acetabular fixation is strongly supported in this age group. The femoral side is a different story: modern cemented tapered stems (Exeter, C-stem) achieve up to 100% survivorship at 7–10 years, and the authors argue cement remains a legitimate first choice for femoral fixation in most patients.
When a young patient asks about hip resurfacing, cite the 1.46% femoral neck fracture rate from 3497 Australian hips. Varus placement and neck notching are the avoidable technical errors. The authors' warning that early enthusiasm outpaced the evidence presaged the subsequent decline of resurfacing after metal-ion concerns emerged in the early 2010s.
The global preference for cementless implants. Documented here as not evidence-based. Is a testable board concept and a reminder that surgical fashion does not always follow data.