Early Development of Total Hip Replacement

Total hip replacement effectively began in the UK in 1938 and has led to widely used, commercially successful, mass-produced devices that relieve pain for an ever increasing period. The Witness Seminar, chaired by Mr Alan Lettin, discussed the remarkable postwar collaboration of British surgeons, engineers and manufacturing firms in the development of efficient alloys, surgical procedures, instruments and the implementation of clean, bacteria-reduced air in enclosed operating theatres, as illustrated by successful prostheses and techniques developed in Norwich (Kenneth McKee), Wrightington (Sir John Charnley), Stanmore (John Scales), Redhill (Peter Ring), and Exeter (Robin Ling and Clive Lee). Early failures – such as loosening from infection, osteolysis, and wear debris – stimulated the search for improved materials and fixation methods, as well as the addition of antibiotics to bone cement to reduce infection. National hip registers that record the survival of different implants were adopted in Europe in the 1970s (2003 in the UK), and they pinpoint the successful devices, as measured by survival and low rates of revision. An introduction to the volume by Dr Francis Neary and Professor John Pickstone, and appendices on materials by Professor Alan Swanson; on international standards by Mr Victor Wheble; and of details of selected prosthesis supplement the transcript.