This 1948 Moynihan Lecture by Smith-Petersen traces the 25-year development of mould arthroplasty of the hip. It covers the evolution of the surgical approach, iterative material testing, the biological principle of guided metaplasia, and outcomes across five diagnostic categories in over 500 cases at Massachusetts General Hospital.
Every total hip replacement performed today traces its conceptual lineage to this paper. Before Smith-Petersen, hip arthroplasty failed for three reasons: traumatic approaches that could not expose the acetabulum, inadequate instruments, and perishable interposition barriers that degraded before repair occurred.
The practical lesson for the operating room: both sides of the joint must be reconstructed with congruous surfaces. A procedure confined to reshaping the femoral head without acetabular reconstruction does not create a joint with lasting function — Smith-Petersen demonstrated this failure explicitly.
When operating through the anterolateral approach, divide the direct head of the rectus femoris flush at the anterior inferior iliac spine. Leaving a stump causes calcification and permanent flexion loss. A technical error Smith-Petersen identified after 53 revision cases.
The vitallium cup described here is the direct predecessor of the McKee-Farrar metal-on-metal prosthesis and, philosophically, of Charnley's cemented total hip. The guided metaplasia principle also underpins modern hip resurfacing arthroplasty.
This 1948 Moynihan Lecture by Smith-Petersen traces the 25-year development of mould arthroplasty of the hip. It covers the evolution of the surgical approach, iterative material testing, the biological principle of guided metaplasia, and outcomes across five diagnostic categories in over 500 cases at Massachusetts General Hospital.
Every total hip replacement performed today traces its conceptual lineage to this paper. Before Smith-Petersen, hip arthroplasty failed for three reasons: traumatic approaches that could not expose the acetabulum, inadequate instruments, and perishable interposition barriers that degraded before repair occurred.
The practical lesson for the operating room: both sides of the joint must be reconstructed with congruous surfaces. A procedure confined to reshaping the femoral head without acetabular reconstruction does not create a joint with lasting function — Smith-Petersen demonstrated this failure explicitly.
When operating through the anterolateral approach, divide the direct head of the rectus femoris flush at the anterior inferior iliac spine. Leaving a stump causes calcification and permanent flexion loss. A technical error Smith-Petersen identified after 53 revision cases.
The vitallium cup described here is the direct predecessor of the McKee-Farrar metal-on-metal prosthesis and, philosophically, of Charnley's cemented total hip. The guided metaplasia principle also underpins modern hip resurfacing arthroplasty.