Trends Biomater Artif Organs Vol 19 1 of ppTotal 15 26 Chronology Hip 2005 Joint Replacement and Materials Development 15 http www sbaoi org Chronology of Total Hip Joint Replacement and Materials Development Sumit Pramanik1 Avinash Kumar Agarwal2 and K N Rai1 1Department of Material Science Programme 2 Department of Mechanical Engineering Indian Institute of Technology Kanpur Kanpur 208016 India Corresponding Author s email akag iitk ac in The development of hip joint materials is one of the most challenging problems to prostheses technology in this millennium Several types of materials have been developed for this purpose The materials like glass polymer poly tetra fluoro ethylene PTFE or Teflon and ultra high molecular weight polyethylene or UHMWPE metal stainless steel CoCr alloy and CoCrMo alloy ceramics alumina zirconia Ti coated ceramic alloys and high isostatic pressed alumina or HIPed Al2O3 composite and apatite materials have been tried with partial success Currently Hydroxyapatite HA is being used quite frequently all over the world Hip joint replacement techniques have been discussed under four different classifications i e hip arthroplasty femoral stem acetabular cup and finally total hip arthroplasty THA Chronology of technical improvement over first generation alternative joint bearing technologies before 1950s have been presented by Charnley and other scientists Before 1960s there was hardly any technique with predictable results The modern Charnley s low friction UHMWPEon metal technique was the actual invention of the total hip replacement THR technique The main objective of this paper is to list all the efforts in the direction of total hip replacement technique and material development chronologically All historical and recent efforts for developing suitable materials and various designs have been covered in detail Towards the end of the paper the current trends and direction in material development techniques and the areas of research have also been emphasized Introduction The hip joint consists of a ball and socket joint The top of the thighbone femur is a largest bone of human body called femur joins with the horizontal pelvic coxal bone and lower end of that is fixed at the knee The ball femoral head at the top of the thighbone fits into a portion of the pelvic bone forms the cup acetabulum or socket as shown in Figure 1 a Between joining surfaces of the acetabulum and femoral lies a smooth glassy substance called cartilage It provides frictionless cushion for constrained motion to femoral head within acetabular socket as shown in Figure 1 b Any failure eminating from acetabulum to femoral bone produces most common hip joint diseases in human body Humans suffer from the various hip joint problems namely osteolysis osteoarthritis avascular necrosis rheumatoid arthritis fracture neck of femur other inflammatory arthritis developmental dysplasia Paget s disease arthrodesis fusion takedown tumour road accidents soldier s injuries etc Meaning of the medical terminology of some of these diseases is discussed below Lumbar Vertebrae Ilium Sacrum Coccyx Hip Joint Pubis Ischium Femur Actabulu Pubic Symphysis Figure 1 a Front View of Pelvic Bone 16 Sumit Pramanik Avinash Kumar Agarwal and K N Rai distribution of the bony trabeculae in the neck The incidence of fracture neck of femur is higher in old age Figure 1 b Acetabular Cup over Femoral Head Osteolysis It is local loss of bone tissue and appears because of wear Destruction of bone takes place especially by bone resorption through removal or loss of calcium Osteolysis may be evident in neoplastic infectious metabolic traumatic vascular congenital and articular disorders 1 Osteoarthritis OA It is degenerative arthritis disease because a wearing out involving the breakdown of cartilage in the joints and is one of the oldest and most common types of arthritis It is characterized by breakdown of the joint s cartilage Cartilage is part of joint and cushions ends of the mating bones The bones get deformed and even small movements will cause friction between the ball and the socket of the hip causing severe pain Avascular Necrosis This is caused by lack of blood supply into bone This condition may ultimately lead to bone death Pain usually develops gradually and may be mild initially If avascular necrosis progresses bone and the surrounding joint surface may collapse causing increase in pain Rheumatoid Arthritis RA This involves inflammation in the lining of the joints and or other internal organs RA produces chemical changes in the synovium that cause it to become thickened and inflamed In turn the synovial fluid destroys cartilage Rheumatoid arthritis typically affects many different joints and it is a chronic inflammatory joint disorder Fracture neck of Femur This is simply the fracture of the neck of femur The structure of the head and neck of femur is developed for the transmission of body weight efficiently with minimum bone mass by appropriate Developmental Dysplasia Developmental Dysplasia of the hip is a condition in which the femoral head has an abnormal relationship to the acetabulum It includes frank dislocation luxation partial dislocation subluxation or instability of the hip wherein the femoral head comes in and out of the socket Radiographic abnormalities reflect inadequate formation of the acetabulum Since many of these findings may not be present at birth the term developmental more accurately reflects the biologic features than the term congenital Paget s Disease It is a metabolic bone disorder of unknown origin This normally affects older people Bone is a living tissue and is constantly being renewed Paget s disease of bone causes increased and irregular formation of bone The bone cells which are responsible for dissolving body s old bones and replacing them with new ones become out of control Arthrodesis Fusion Takedown Arthrodesis means surgical fixation of joints by promoting fusion through bone cell proliferation It provides potential of a painless stable base of support Most frequent complication of arthrodesis is non union Etiology of non union includes bone loss persistent infection incomplete bone apposition limb misalignment and inadequate immobilization Tumour The surgical problems encountered with osteoid osteomas of the proximal femur are unique En bloc surgical excision is often made difficult by problems in defining the tumour boundaries This can lead to extensive resection requiring
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