History of THA Development

Historically, interposition arthroplasty was initially introduced, which involved resecting an ankylosed and immobile joint surface and inserting a membrane material to prevent rejection of the bone ends. In 1902, Robert Jones inserted gold foil into the articular surface; Murphy inserted the fascia and adipose tissue [1] to avoid bony ankylosis of the joint. However, these intermediate insertions did not provide stable load-bearing results for the lower limb joints. Smith Petersen in the United States attempted to improve interposition arthroplasty and devised a cup-shaped mold (mold arthroplasty) in 1923; it was inserted into the hip joint such that fibrocartilage was formed spherically in the acetabulum and femoral head [2]. Initially, cup arthroplasty was performed using artificial materials such as glass, Pyrex, and Bakelite; however, short-term failures occurred due to material failure. The use of vitallium (65% cobalt, 30% chromium, and 5% molybdenum), a corrosion-resistant metal developed in 1932, made it possible to avoid implant material failure from 1938 onwards. In this method, the inserted cup-shaped implant was not fixed to the pelvis or femur. Since it was cast to shape the fibrocartilage formation from the subchondral bone into a spherical shape, the cast was removed once the fibrocartilage regenerated. In practice, however, simply inserting the cast provided pain relief and improved mobility; furthermore, patients often refused the procedure to remove it; therefore, it was left in place. In vitallium cup arthroplasty, bone resorption of the femoral head and upper migration of the cup to the acetabulum lead to leg shortening and greater trochanter elevation (Fig. 1.1), resulting in the distal transfer of the greater trochanter and cup replacement required in many cases. In 1957, Aufranc reported the results of 1000 cup arthroplasty cases performed at the Massachusetts General Hospital over 15 years and found a revision rate of 22.5%, which was considered a very good result for arthroplasty at that time [3]. Until the late 1960s, cup arthroplasty was the standard surgical treatment for degenerative hip joint diseases. Although this method differs from total hip arthroplasty (THA), developed in later periods, as the inserted implant was not fixed to either the pelvis or femur, Norman Sharp underwent cup arthroplasty in 1948. On June 28, 2019, 70 years and 209 days later, he was awarded a place in the Guinness Book of World Records for the longest-lasting hip replacement.