While performed less frequently than surgery to replace the knee joint, more than a million patients worldwide undergo hip replacement surgery each year. Furthermore, the number of patients who require this procedure is increasing year on year. Part of that increase is due to the number of younger people that now need a prosthetic joint. Until the turn of the century, it was almost exclusively those aged 65 and over that surgeons were treating. Today, that threshold has fallen by at least ten years, and surgeons frequently report cases of even younger subjects needing arthroplasty.
Patients who have received a hip replacement or are waiting for one will probably be shocked to learn that it is 130 years since a surgeon first attempted to perform this procedure. In 1891, a German named Glück attempted to provide relief for patients with damage to the joint caused by TB. He removed the damaged bone and replaced it with a prosthesis fashioned from ivory. Unfortunately, ivory lacks the strength of healthy bone, so the prosthesis collapsed when placed under pressure.
Nevertheless, Gluck’s concept inspired others who would eventually develop a successful hip replacement procedure. Naturally improved surgical techniques played a significant role in the development stages and have continued to do so. For example, some of those early orthopaedic surgeons experimented with joint resurfacing, inserting pig’s bladder or skin tissue between the bones as a means to reduce friction and the resulting pain. However, the characteristic longevity of modern prosthetic joints would not have been possible without a series of advances in materials science.
The prosthetic components must utilise durable and biocompatible materials for a hip replacement to provide long-term service. Some 30 years later, fitting a glass mould over the femoral head seemed like a promising option but, although glass is biocompatible, it proved to be too brittle. Ultimately, stainless steel provided the initial breakthrough that, in time, would see this type of surgery become routine. Today, the use of metal-on-metal prostheses has declined in favour of the metal-on-plastic (polyethylene) option. Many surgeons now regard this as the gold standard due to its cost-effectiveness, safety and predictability.
Patients that require a hip replacement often present with different needs that might require alternative approaches by those performing the surgery. For that reason, orthopaedic surgeons intending to specialise in arthroplasty must undergo additional intensive training to master the various techniques that have served to make this procedure so successful.
The orthopaedic team at Pretoria’s Life Wilgers Hospital has honed those skills to the point where the unit is now a national and international referral destination of choice for patients requiring arthroscopy, hip, knee or shoulder arthroplasty.