Total hip arthroplasty during last 25 years




arthroplasty, hip joint


Total hip arthroplasty (THA) is among the most clinically effective and the most cost-effective orthopaedic surgeries in the past 5 decades. The fixation durability of a well-done cemented femoral stem remains the standard against which all newer fixation techniques are measured. Stem survival was 82 % for 20 years and 81 % for 30 years. In contrast, the acetabular cup survival rate was 71 and 52 %, respectively. Cemented cup use decreased from 12 % in 1995 to 7.8 % in 2001 in the North American Hip and Knee Registry. Clinical data have consistently demonstrated no sustained clinical advantages of the minimally invasive surgery over conventional surgical approaches. Moreover, this method is quite often associated with complications. There has been a dramatic reduction in the enthusiasm and clinical application of minimally invasive procedures in THA over the past decade according to the data from national registries. There was a consistent growth of hip resurfacing worldwide since 1993. By 2008, hip resurfacing accounted for 6–9 % of all THAs. Despite continued intense patient interest, concerns regarding the complications and the long-term implant survival rate and unknown implications of metal ion and related adverse tissue reactions have led to a reduction in the number of superficial hip arthroplasty in most countries. Innovations in the processing of the polyethylene have resulted in improved wear characteristics. The ideal polyethylene material should have a high density of cross-links (strong intermolecular forces) and a low potential for oxidation. This is achieved by increasing the radiation dose given to the polyethylene (up to 10 Mrad), which increases the amount of cross-links. To decrease the oxidation potential, components are now irradiated in oxygen-free environments with barrier packaging. There is limited evidence regarding comparative effectiveness of various hip implant bearings. Randomized clinical trials show similar short to mid-term survivorship among ceramic-on-ceramic (CoC), ceramic-on-highly cross-linked polyethylene (XPE) and metal-on-XPE in patients younger than 65 years. Ceramic heads are getting increasing popularity compared with metal heads. Huge differences still exist amongst countries in the rate of using cemented and cementless fixation. In some countries, the cemented stems were used in less than 4 % of cases in 2013, in other countries — in more than 68 % that same year. All around the world at the moment, there is still a tendency towards an increase in the number of cementless fixations. The Nationwide Inpatient Sample database demonstrates the causes for revision THAs. Three most common causes among the 51,345 revision THAs were dislocation (22.5 %), aseptic loosening (19.7 %), and infection (14.8 %). In 2030, the clinical demand for primary THAs would increase by 174 %, to 572,000 cases per year compared to 2002, and the demand for revision THAs would increase by 137 %.


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