Arthroplasty of the hip. The search for durable component fixation

The primary indication for arthroplasty of the hip is the elimination of pain and the restoration of function. This paper addresses the progression of developments leading to the present satisfactory attainment of this goal. Having achieved this goal, patients and surgeons have come to expect far more than the necessities of pain relief and improved function. They have begun to expect replacements that will last "forever" and allow the recipients of these devices to lead lives that are more physically active. In this paper, approaches to this new goal are summarized, including the current state-of-the-art attempts at utilizing biologic ingrowth fixation. The numerous real and potential problems associated with achieving this goal are delineated, many of which remain unsolved. Finally, the necessity of uniform techniques and methods of evaluation is beseeched so that results of new innovations can be analyzed earlier and more critically.