Evaluación de la calidad de vida

Since its emergence, THR surgery had significant progress while it begins with a very rudimentary surgery to the modern THR surgery with highly durable materials. The following material will review this development during these years.

In the first time, in 1821, Anthony White (1782-1849) of the Westminster Hospital in London had done the surgery; however he did not publicize or even make a report of it [30]. In this operation surface of the joint was changed hence it provided the mobility and relief the pain, though it failed in the case of stability.

In 1826, for the first time hipbone was cut and some part was removed by John Rhea Barton (1794-1871) in Philadelphia. He did this surgery without anaesthesia in seven minutes and the patient could walk with cane, three months after the operation. Although this surgery had primary successes, it failed in six years later. Borton was the first person who proved that the motion prevents the bone fusion. He reported the surgery in the North American Medical and Surgical Journal [31].

Vitezlav Chlumsky (1867-1943) was the Czech surgeon who experimented with many materials for the hip prosthesis like: celluloid, rubber, Magnesium, Muscle, glass, zinc, pyres, decalcified bone, wax and silver plate [32]. He tested these materials in animals before implanting in his patients.

In 1891, Professor Themistocles Glück was the first person who implanted the actual total hip prosthesis in human body. He made the femoral head and socket with ivory and screwed them to the bone with nickel plated screws. “Furthermore he experimented with mixture of plaster of Paris, and powder pumice with resin for fixation” [33]. Glück was also the first person who proposed the biocompatibility of the

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material in human body. Due to this idea he used ivory for his artificial hip joint in human body, the material of which is very akin to human bone. Also he found that the cavity in the bone, bone marrow cavity, could accept the stem of the artificial hip joint if it is stably fixed in.

In early 1900, Foedre (b.ca. 1860), a French surgeon, noted that the pig bladder could withstand the stress and the intra articular pressure. In 1918, William Steven Bear (1872-1931) used pig bladder at the John Hopkins Hospital while there were not the modern surgical procedures and the surgery had been done with Hippocratic tradition which was a surgery with no anaesthesia [34].

During this period of time Sir Robert Jones (1855-1933) covers the made femoral head with a strip of gold. It was effective for twenty-one years in the body of a patient such that the patient could retain the motion of the joint for twenty-one years. He reported this success [35] as it was the longest duration of effective technique in the history of arthroplasty.

In 1924, Royal Whitman (1857- 1946) reported the first new method in surgery of osteoarthritis other than fusion. He described the surgery in annals of surgery [36] when he worked in Hospital for Rupture and Crippled in New York City. In the operation, the femoral head was removed and the trochanter and its attached muscles were cut obliquely. Hence the new area was provided together with the remained part of the neck, which could provide a secure weight.

American surgeon Marius Smith Petersen (1886-1953) made a hollow hemisphere, which was made with moulded glass, in 1923; this piece could fit on the femoral head and form the smooth interposition material between femoral head and acetabulum. He believed that the glass has not only a good biocompatibility but also it has a smooth surface with low friction. He fitted this device over the femoral head of the patient in 1932, however this method failed quickly due to insufficient withstanding of glass in the face of the stress of walking and weight pressure. Although he obtained a significant success in case of biocompatibility and smoothness, stubbornness of the patient convinced him to abandon glass. After that he used celluloid, Pyrex and Bakelite until he met his dentist in 1937 when he advised to use Vitallium by him. In that time Vitallium had recently been introduced to the dentistry market. Smith Petersen used 500 Vitallium in the hip joint [37], which had the predictable result in arthroplasty history when it had 10 years successful clinical result. Vitallium is made of cobalt, chromium

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and molybdenum, which it not only does not react to the human tissues also it is very strong and resistant to the corrosion. Therefore, it is still used nowadays.

In 1948, French Judet brothers, Robert (1901-1980) and Jean (1905-1995), used acrylic to make a hip resurfacing [23] while in this process the cartilage of the femoral head is removed and replaced by the metal cap. This process could save the hip joint 20- 30 years but unfortunately this material is loose and fails very quickly.

In 1950, Frederick Röeck Thompson (1907-1983), Harold R. Böhlman (1893- 1979) and Austin Moore (1899-1963) refined the concept of Judet brothers and developed a use of the vitallium to make a hip joint prosthesis. They worked separately to achieve similar aims, which were to make a stable, high durable and biocompatible hip joint and could withstand the stress of walking and pressure of the human weight. By this time the mentioned aims became clear and the artificial hip joint had been made, consisting of a single piece with ball fitting to the acetabulum and a vertical stem inserted into the bone marrow cavity. Dr. Moore was honoured to be the first person, who replaced the twelve inches of the destroyed femur by a tumour, with a new vitallium prosthesis at John Hopkins in 1940 [24]. The prostheses is illustrated in Figure 2.15.

Figure 2.15. Twelve inches prothesis was replaced by Dr.Moore in 1940 [24]

Kenneth McKee (1905-1991) used dental acrylic as a cement to fix the femoral and acetabulum components. He also used Thompson prosthesis for the femoral side, which was fixed to the three-claw type cup acetabulum component. The cup was screwed into the acetabulum but it failed due to loosening. Moore and Böhlem developed the invented prosthesis to the one with pores to allow the femur bone in growth, in 1952. Although Moore and his colleagues had a significant progress in making femoral head parts, they failed to make the acetabulum component.

In 1958, a British orthopaedic surgeon, Sir John Charnley (1911-1982), introduced the new technique to reduce the wear of the socket, which was replaced under eroded parts of the socket with a Teflon material. Although Teflon component

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failed, it posed the idea and paved the way for replacing the eroded part of the socket with soft material with flexibility. He used polyethylene polymer when Teflon failed. He used PMMA as a bone cement, to fix the socket to the acetabulum; and the ball and the stem to the femoral bone [40].

In 1964, another British surgeon, Peter Ring (b.1922) worked on the cement-less fixation with a metal on metal hip joint prosthesis. He achieved some good result in the first several surgeries with up to 97% success within 17 years of follow up [21]. Although his fixation method abandoned in 1970 due to the some advantages of Charnley’s model (Figure 2.16), pursued by British and Swiss surgeon in 1980s. Nowadays various kinds of materials including metal on metal bearing are under investigation.

Figure 2.16. Evolution of Charnley prostheses, which is from the flat black stem to the C shape stem [21]

In the 1970’s, first Ceramic on Ceramic hip prosthesis was implanted in the body of the vice president of ceramic company by French surgeon Pierre Boutin. Boutin started to work with him to develop the ceramic prosthesis. In 1974 the first generation of ceramic prosthesis, Al2O3, produced, which had large grain size causing low mechanical strength and failed. In 1992, the second generation of ceramic was produced with finer grain size and lower level of impurity. In 1995 using Hot Isostatic Pressing (HIP) technique, the grain size reduced further thus the mechanical properties in terms of durability, wear rate and resistance to fracture were improved in the third generation of ceramic (Biolox Forte). In 2000, the fourth generation of ceramic (Biolox Delta) was produced with composite of the 82% Alumina, 17% Zirconia, 0.3% Chromium oxide and 0.6% Strontium Oxide that reduced the wear rate by absorbing the crack energy

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which will be explained further in this chapter. The properties of the ceramic prosthesis from first generation to fourth one, has been written in Figure 2.17.

Figure 2.17. The properties of first, second, Third and Fourth generation of Ceramics [42]