The earliest recorded attempts of replacing a hip joint hail back to 1891 when the ball on the femur was replaced on a patient in Germany, using ivory, and fixed to the bone using nickel-plated screws. Later, Czech surgeon, Vitezlav Chlumsky, working in Germany, experimented with many materials for hip prostheses, including silver plates, rubber struts, magnesium, zinc, glass, decalcified bones, wax and human muscle.4
Along the same time, Sir Robert Jones used a strip of gold foil to cover a reconstructed femoral head; twenty-one years later, the patient still retained effective motion of the hip joint making it the longest “successful” hip joint replacement to date.4 Teflon was also experimented with during the 1930’s, however these prostheses generally wore out with a couple of years, causing the patients to suffer osteolysis, in which the bone dissolves and is re-absorbed by the body.
Nearly half a century after the first clumsy attempt at replacing a hip joint, an American surgeon at Johns Hopkins hospital and an American surgeon implanted a femoral replacement with a large, fixed head, made of Vitallium—a cobalt and chromium alloy. The femoral replacement was about a foot in length, and was bolted to the end of the femoral shaft.5 A later version of this prostheses, designed by Dr. Austin T. Moore, is still in use today. Orthopedic surgical hip procedures owe a great deal of their current development to the military conflicts occurring during the first half of the century.
By the early 1950s, Dr. McKee, a British orthopedic surgeon designed a prosthesis which implemented a “three-claw” type cup, which screwed into the acetabulum, however due to the lack of an adequate type of cement to hold the prosthesis in its place, there were many surgical failures. Dr. McKee later concluded that the most important aspect of a successful hip implant was to obtain a firm fixation, first using screws, then later acrylic cement.
In 1960, a Burmese orthopedic surgeon, Dr. San Baw, used an ivory hip prosthesis to replace the fractured hip bone of an 83-year-old nun. Dr. Baw continued using these ivory implants between 1960 and the 1980’s, implanting some 300 of them, and achieving a success rate of 88%. It is believed that ivory was used because it was cheaper at the time than metal, and may also have had certain biomechanical properties which promoted bonding with nearby human tissue.
In 1964, an English surgeon, Dr. Peter Ring, developed a cement-less component with a metal-on-metal articulation; some of these surgeries provided surprisingly good results. Today’s modern artificial hip joint owes much of its success to Professor John Charnley who, in the 1970’s, completely re-designed the traditional hip prostheses. Charnley’s design included a stainless steel femoral component which connected to a polyethylene acetabular component. Both parts were fixed to the bone, using a innovative new bone cement. This design implemented a small femoral head, making it suitable for older, less mobile patients, however created much less friction. For the next two decades, the “Charnley Low Friction Arthroplasty” was the most used hip implant device in the world.