How to Do a Cementless Hip Arthroplasty

Since the early 1960s, when Sir John Charnley was performing cemented total hip replacement (THR) regularly with good results, techniques and component designs have been improved substantially. At that time THR was mainly an operation for elderly patients crippled with arthritis. Today, however, young patients with hip disease increasingly hope to restore their quality of life, which typically includes physically-demanding activities. As cement fi xation can break down over time, there has been considerable effort and research especially in trying to enhance the methods of fi xa-tion. The goal was to create a living type of bond between implant and bone, which would be longer-lasting and stronger than the cement-bone-interface. Advances in bioengineering technology have driven the development of cementless hip implants with textured surfaces, which allow bone in -growth. Recent studies suggest, that uncement ed hips can provide durable fi xation as well as cement ed implants. In addition, better materials and designs have allowed the use of large-diameter bearings which provide an increased range of motion with enhanced stability and very low wear. Less invasive surgery can limit soft-tissue damage and might facilitate accelerated discharge and rehabilitation. Currently, studies are being performed to evaluate whether computerassisted surgery can contribute to reproducible and accurate placement of implants, which is still a crucial factor for long-term survival especially in uncemented THR.

We will briefl y describe the different anchorage concepts of the most popular uncemented implants and available bearing materials. Then — after an overview on widely-used surgical approaches — a very basic description of implantation technique, potential complications and rehabilitation principles is provided. In order to compare different implant and approach philosophies, a short summary of available long-term studies will be presented.