Hip replacement surgery is in no doubt one of the most important orthopaedic advances over the last 70 years which has has eased suffering and disability worldwide. After more than 60 years since its implantation, the time has arrived to find ways of using modern biotechnology to resurface defects in joints, just like dentists have done with cavities to avoid the destruction and removal of healthy teeth. Rudimentary efforts have been documented throughout the history of hip replacement surgery from as early as the 17th century. Among the more daring was the experimental use of materials such as; celluloid, silver plates, rubber struts, magnesium, zinc, glass, pyres, de calcified bones, wax, muscle tissue and celluloid. Of course there were no long term success stories recorded whilst experimenting with these materials as the human body almost always reacted against them. These materials were also unable to cope with the stresses of supporting body weight for long periods of time. The early experimental days did however start paving a way for surgeons’ attempts towards successful hip replacement surgery. Primitive operations were performed to replace only one joint and came with a high risk of infection, inherent before the advent of antibiotics... Artificial hips were gradually gaining notoriety and interest within medical circles circa the 1930s though it was rare for someone to undergo full hip replacement surgery then. Experimental attempts to replace joints with Teflon seemed like a good idea at the time, but Teflon prosthesis wore out within two to three years and eventually patients suffered osteolysis, which is when bone starts to dissolve and be reabsorbed by the body. Even though these hip replacement surgeries seemed rudimentary, they were considered a better alternative to the crippling, pain endured by those suffering arthritis. One of the major problems with experimental materials was that the articulating surfaces inserted in the joints were unable to be naturally lubricated by the body which caused them to wear down and loosen which made it necessary to replace the joints again via revision surgery. Artificial joints were eventually manufactured from steel or chrome which had a better ‘hip life’ due to superior strength and their non corrosive quality.  Orthopaedic surgery owes a great deal of its development to its role in military conflicts which occurred throughout the first half of the century... Advancements and ideas behind them... Dr. McKee By the early 1950s, a British orthopaedic surgeon, had designed a prosthesis on the femoral side that articulated with a three claw type cup that screwed into the acetabulum (the surface of the joint that the ball joint fits into). The initial high incidences of failure resulted from the loosening of components as there was no adequate holding cement available to keep the prosthesis in place for long periods of time. It was throughout the 1960s that Hip replacement surgery became more widespread and available to patients. At the XIX World Congress of Surgery/International College of Surgeons (1974) Dr. McKee presented results from the first 300 total hip prosthesis and concluded that the most important principle was to obtain the firm fixation of components in the bone using screws, then later using acrylic cement. Dr. San Baw In   1960   a   Burmese   orthopaedic   surgeon,   Dr.   San   Baw   who   was   chief   of   the   orthopaedic   surgery unit   at   the   Mandalay   General   Hospital   in   Burma   pioneered   the   use   of   ivory   hip   prostheses   to replace united fractures of the neck of the femur. Dr.   San   Baw   at   first   bravely   used   an   ivory   prosthesis   to   replace   the   fractured   hip   bone   of   an   83 year   old   Burmese   Buddhist   nun.   He   continued   his   work   up   until   the   1980s’   with   considerable success and is now famous for it.   Dr.   Peter   Ring ,     from    Surrey,    England    started    his    clinical    experience    with cement    less    components    with    a    metal-on-metal    articulation    in    1964.    Some    of    his    early Arthroplasty   surgery   provided   surprisingly   good   results   with   up   to   97%   of   implants   surviving years of follow up. Sir John Charnley The modern artificial joint owes much to the work of Professor John Charnley from the Manchester Royal Infirmary. Dr. Charnleys’ work throughout the 1970s’ in the field of tribology resulted in a design that completely replaced previous designs prior to the 1970s. Charnley's design consisted of three parts which were: a stainless steel metal femoral component (the ball attached to the femur) which connected to an Ultra high molecular weight polyethylene acetabular component. Both of these prosthesis were fixed to the bone using the third and last element; a specially manufactured bone cement. The replacement joint was known as the Low Friction Arthroplasty and was lubricated with synovial fluid. The small femoral head on occasion produced wear and tear problems which made it suitable only for much older patients with less mobility, however there was a huge reduction in resulting friction which led to excellent clinical results. For over two decades, the ‘Charnley Low Friction Arthroplasty’ design was the most used system in the world, far surpassing other available options created by McKee and Ring.  Dr Charnley was eventually knighted by the Queen for his innovation and efforts within prosthesis surgery that helped thousands of patients throughout the world. Since then improvements in joint replacement surgery, techniques and the technology used have increased the effectiveness of total hip replacement, though it still remains an invasive and aggressive surgical procedure.   Modern day Prosthesis surgery.. Throughout the last decade, several evolutionary developments have been created within total hip replacement procedures and prosthesis. Many hip implants are made of a ceramic material rather than polyethylene, which some research indicates dramatically reduces joint wear. Metal-on-metal implants are also gaining popularity. However several  Orthopaedic manufacturers have now removed this type of hip prosthesis due to the many complications these prosthesis create such as metal corrosion and the infiltration of metal particles within the body. Most implants are now joined without cement; the prosthesis is given a porous texture into which bone grows. However this method is still deemed to be invasive. Hip Resurfacing Surgery... Hip resurfacing is generally used as an alternative to total hip replacement and is often suggested for active patients under the age of 55. Hip replacement surgery was adapted in the 1970s’ and came with some success, but surgeons preferred to opt for hip replacement surgery because of the early complications that resurfacing surgery was causing. Improvements over the last two decades have made hip resurfacing surgery more attractive and can now be a better option for patients, especially younger, active people. Hip resurfacing surgery is very different from hip replacement surgery as the femur head is reshaped, then resurfaced with a metallic shell. A metal socket is then inserted into the pelvis to support the newly resurfaced femur joint. This surgical procedure reduces pain and ensures better joint stability. The chance of dislocation also lowers if resurfacing surgery is performed rather than with a total hip replacement. Revision surgery from resurfacing the hip bones is not as complicated as less healthy bone is untouched.

A Brief History of Prosthesis innovations..

1950s  Dr. McKee  designs a prosthesis on the femoral side that articulates with a three claw cup that screwed into the acetabulum. 1960 Dr. San Baw at the Mandalay General Hospital in Burma pioneers the use of ivory hip prostheses to replace united fractures of the neck of the femur. 1964 Dr. Peter Ring, from Surrey, England starts a clinical trial with cement- less components with a metal-on-metal articulation. 97% of implants survived the years of follow up. 1970s Sir John Charnley replaces previous designs prior to the 1970s. Charnley's design consisted of three parts which connected to an Ultra high molecular weight polyethylene ace tabular component. 2012 With 35 years experience in orthopaedic surgery, and spinal injuries, Dr. Javier Cabrera patents the Bio Total Hip.   

The process of manufacturing prosthesis parts requires large amounts of energy which add onto more unwanted environmental pollution.

 New York, March 2012   A team of 35  International bio scientists, manufacturers and doctors hold a summit on arthritis. Among other conclusions they discuss the Inadequacy of arthritic classification and a need for new treatments for the symptoms of bone cartilage and joint structural abnormalities in the stages of the disease. Concerns in the scientific world about the treatment for Arthrosis and economical consequences of Arthroplasty surgery with its environmental issues are raised.

Dr. Javier M.  Cabrera L.M.S. F.I.C.S. Creator of the Bio Total HIp

First cemented THP  performed in a private hospital by Dr. Cabrera.

The Innovation and technology The innovative design and technology carving a future for Hip Surgery

Do We Need to Expend $83 Billion in Joint Prosthesis? In the ‘Journal of Arthritis’ Dr. J. Cabrera expresses how its become unnecessary for Joint prosthesis surgery and reveals exciting innovative solutions which will lead the new way forward   

In the US alone, 332,000 total hip implants were performed.  Similar surgical procedures on damaged joints were performed in greater numbers, including knees, shoulders and elbows being the most common in need of repair. 

Link to Journal