Chronology of Total Hip Joint Replacement and Materials Development15Chronology of Total Hip Joint Replacement and Materials DevelopmentSumit Pramanik1, Avinash Kumar Agarwal2,#, and K. N. Rai11Department of Material Science Programme2 Department of Mechanical EngineeringIndian Institute of Technology Kanpur, Kanpur 208016, India# Corresponding Author’s email: [email protected] The development of hip joint materials is one of the most challenging problems to prostheses technology in thismillennium. 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 highisostatic 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 techniqueshave 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 alternativejoint bearing technologies before 1950s, have been presented by Charnley and other scientists. Before1960s, there was hardly any technique with predictable results. The modern Charnley’s low-friction UHMWPE-on-metal technique was the actual invention of the total hip replacement (THR) technique. The main objectiveof this paper is to list all the efforts in the direction of total hip replacement technique and material developmentchronologically. All historical and recent efforts for developing suitable materials and various designs havebeen covered in detail. Towards the end of the paper, the current trends and direction in material developmenttechniques and the areas of research have also been emphasized.IntroductionThe hip joint consists of a ball and socket joint.The top of the thighbone (femur) is a largestbone of human body, called femur joins withthe horizontal pelvic coxal bone and lower endof that is fixed at the knee. The ball (femoralhead) at the top of the thighbone fits into aportion of the pelvic bone forms the cup(acetabulum) or socket as shown in Figure 1(a).Between joining surfaces of the acetabulum andfemoral lies a smooth glassy substance calledcartilage. It provides frictionless cushion forconstrained motion to femoral head withinacetabular socket as shown in Figure 1(b).Any failure eminating from acetabulum tofemoral bone produces most common hip jointdiseases in human body. Humans suffer fromthe various hip joint problems namelyosteolysis, osteoarthritis, avascular necrosis,rheumatoid arthritis, fracture neck of femur, otherTrends Biomater. Artif. Organs, Vol 19(1), pp 15-26 (2005) http://www.sbaoi.org ActabuluLumbar Vertebrae Ischium Hip JointSacrum Ilium CoccyxPubis Femur Pubic Symphysis Figure 1(a): Front View of Pelvic Boneinflammatory arthritis, developmentaldysplasia, Paget’s disease, arthrodesis(fusion) takedown, tumour, road accidents,soldier’s injuries etc. Meaning of the medicalterminology of some of these diseases isdiscussed below.16Sumit Pramanik, Avinash Kumar Agarwal, and K. N. RaiOsteolysis: It is local loss of bone tissue andappears because of wear. Destruction of bonetakes place especially by bone resorptionthrough removal or loss of calcium. Osteolysismay be evident in neoplastic, infectious,metabolic, traumatic, vascular, congenital andarticular disorders [1].Osteoarthritis (OA): It is degenerative arthritisdisease because, a “wearing out” involving thebreakdown of cartilage in the joints and is oneof the oldest and most common types ofarthritis. It is characterized by breakdown of thejoint’s cartilage. Cartilage is part of joint andcushions ends of the mating bones. The bonesget deformed, and even small movements willcause friction between the ball and the socketof the hip, causing severe pain.Avascular Necrosis: This is caused by lack ofblood supply into bone. This condition mayultimately lead to bone death. Pain usuallydevelops gradually and may be mild initially. Ifavascular necrosis progresses, bone and thesurrounding joint surface may collapse causingincrease in pain.Rheumatoid Arthritis (RA): This involvesinflammation in the lining of the joints and/orother internal organs. RA produces chemicalchanges in the synovium that cause it to becomethickened and inflamed. In turn, the synovialfluid destroys cartilage. Rheumatoid arthritistypically affects many different joints and it is achronic inflammatory joint disorder.Fracture neck of Femur: This is simply thefracture of the neck of femur. The structure ofthe head and neck of femur is developed for thetransmission of body weight efficiently, withminimum bone mass, by appropriatedistribution of the bony trabeculae in theneck. The incidence of fracture neck of femur ishigher in old age.Developmental Dysplasia: DevelopmentalDysplasia of the hip is a condition in which thefemoral head has an abnormal relationship tothe acetabulum. It includes frank dislocation(luxation), partial dislocation (subluxation), orinstability of the hip, wherein the femoral headcomes in and out of the socket. Radiographicabnormalities reflect inadequate formation ofthe acetabulum. Since many of these findingsmay not be present at birth, the termdevelopmental more accurately reflects thebiologic features than the term congenital.Paget’s Disease: It is a metabolic bonedisorder of unknown origin. This normallyaffects older people. Bone is a living tissue andis constantly being renewed. Paget’s diseaseof bone causes increased and irregularformation of bone. The bone cells, which areresponsible for dissolving body’s old bones andreplacing them with new ones, become out ofcontrol.Arthrodesis (Fusion) Takedown: Arthrodesismeans surgical fixation of joints by promotingfusion through bone cell proliferation. It providespotential of a painless, stable base of support.Most frequent complication of arthrodesis isnon-union. Etiology of non-union includes boneloss, persistent infection, incomplete boneapposition, limb misalignment, and inadequateimmobilization.Tumour: The surgical problems encounteredwith osteoid osteomas of the proximal femurare unique. En bloc surgical excision is oftenmade difficult by problems in defining thetumour boundaries. This can lead to
View Full Document
Unlocking...