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Updated: Jul 29, 2026
Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty
Published on: February 27, 2018
[Criteria for evaluating hip joint arthroplasty]
1Orthopädischen Universitätsklinik Basel.
Insights
Total Hip Replacement (THR) has seen significant progress, reducing complications and achieving high survival rates. Further advancements are now challenged by this high standard, focusing on technique, design, and materials for improved outcomes.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Medical Device Engineering
Background:
- The evolution of Total Hip Replacement (THR) over the past 40 years, initiated by John Charnley's "low friction arthroplasty."
- Significant reductions in THR complications including infection, material failures, thromboembolism, and aseptic loosening.
- Current 10-year survival rates exceeding 97% represent a benchmark that also poses challenges for further innovation.
Purpose of the Study:
- To review the development and current state of Total Hip Replacement (THR) technology.
- To identify key factors influencing THR assessment and outcomes.
- To discuss methods for predicting THR survival based on clinical and radiographic criteria.
Main Methods:
- Review of historical development and current literature on Total Hip Replacement (THR).
- Analysis of critical factors affecting THR performance: operative technique, prosthesis design, surface characteristics, and materials.
- Examination of subjective clinical and objective radiographic criteria for prognostic assessment of THR survival.
Main Results:
- THR has achieved a high standard of performance with reduced complications and excellent short-term survival rates.
- Key determinants of THR success include surgical technique (cementing), implant design, material properties, and interface characteristics.
- Radiographic indicators such as radiolucency, osteolysis, and migration at the implant-bone interface predict poorer outcomes.
Conclusions:
- The high success rate of modern Total Hip Replacement (THR) presents a barrier to further significant advancements.
- Future progress in THR hinges on optimizing operative techniques, prosthetic design, biomaterials, and understanding implant-bone interactions.
- Radiographic monitoring of implant-bone interface changes is crucial for predicting long-term THR survival and patient outcomes.
Abstract:
Development and state of the art of the Total Hip Replacement (THR) are reviewed. Progress since the introduction of the "low friction arthroplasty" by John Charnley/UK over 40 years ago consists first of all in an impressive reduction of the number and severity of complications: infection, failures of materials, thromboembolism and aseptic loosening. Current 10 year survival rates should not be lower than 97%. This high standard of THR performance has become the greatest obstacle to further progress. The most important factors for the assessment and the outcome of a THR are the operative (cementing) technique, the mechanical design of the prosthesis, the characteristics of the surfaces (implant, bone cement, bone) and the materials used. A prognosis of the survival of a THR can be made based on negative subjective clinical and negative objective criteria. On X-ray films these criteria are shown first of all as changes (radiolucency, osteolysis, progressive migration) at the implant-bone interface and within the periprosthetic bone itself.
