The first 32 years of total hip arthroplasty. One surgeon's perspective

During the first 32 years of total hip arthroplasty, high risk of sepsis, improved prevention of infection, problems of loosening, new disease of bone lysis secondary to particulate debris, and the complexities of cementless fixation have taught orthopedic surgeons many lessons. These lessons include the following: (1) In cemented THA, bone cement can be made five-times stronger just by porosity reduction; the critical interface in a cemented femoral stem is the cement-metal interface, not the cement-bone interface; and no one has solved the long-term fixation problem in cemented sockets. (2) In cementless implants, the disuse osteoporosis that occurs around cementless femoral components can be severe; the use of cementless implants does not eliminate bone lysis; only small amounts of bone ingrowth occur in many cementless implants, particularly in revision cases; and little or no bone ingrowth occurs from grafts. Today, however, some of these lessons are ignored by surgeons. If progress is to be made in arthroplasty, these lessons from the past should be learned and warning signs of the present should be heeded.