Lessons learned in 30 years of total hip arthroplasty

Lessons learned in 30 years of total hip arthroplasty (THA) include the following: Know and understand the evolution of hip arthroplasty. Selection of the prosthesis must be carefully made from sound clinical and scientific data. Before embarking on a prosthesis program, establish an immediate and a prospective protocol for the operation during the neosurgical period and for an indefinite long-term follow-up period. Establish a data bank for easy and complete retrieval of all pertinent material. Be familiar with the basic biomechanical principles of load and stress about the hip. Learn to use polymethylmethacrylate properly. The author's studies, and others, have shown that with newer, improved methods, results are excellent. Do not accept biologic (ingrowth) fixation as the ultimate aim in THA. Many problems are emerging with biologic fixation. Be wary of the complications in THA that relate to technique as well as design and even patient selection. Loosening, infection, continued pain, ion absorption, stress shielding, possible malignancy, and foreign body reaction are all complications that must be addressed. A surgeon should never lose the ability to review his or her own experience with unbiased, objective scrutiny.