Current evidence in designs and fixation surfaces in total hip arthroplasty

Abstract

Since its introduction in the 1960s, total hip arthroplasty (THA) has proved to be an excellent and reliable mode of treatment for the end stages of hip pathology, with satisfactory clinical outcomes at 15-20 years [1-4]. Following the initial problems which the pioneers accounted in the 1960s and 1970s (such as surgical technique, structural design failures, and infection), in the 1980s, orthopaedic surgeons faced problems of choice of both acetabular and femoral components and the selection of cemented or cementless implant fixation. Soon afterwards, it was proved that the above dilemmas had been misleading since the long-term survival of a THA is a multifactorial issue, since, other than the implant, factors related to the diagnosis, the patient, the surgeon, and surgical technique are also important (Fig. 1.1). However, until now, the implant has been easy to blame for failures. A possible explanation is the fact that we do not have strong evidence supporting implant design and fixation principles. Instead, we have evidence of good and bad recipes, surgeons having learned from devastating clinical failures and patients having often been "fashion victims" [5]. © 2014 Springer-Verlag London. All rights are reserved.