Possibilities and Limitations of the Cementless Fixation of Endoprosthetic Components

Abstract

The evolution of technology differs from the phylogenesis of biological systems in that it is mediated by the human intellect. Biological development follows inevitably from the laws that relate form with function and is a continuous process. As technology progresses, on the other hand, it is easy to lose sight of the problems that the technology was originally intended to solve. The fixation of a femoral head prosthesis with polymethylmethacrylates by Charnley (1960) was the culmination of many attempts to replace natural joints or joint components with artificial parts. The early attempts of Groves (1890), the Judet prosthesis (1956), and the “mould arthroplasty” of Smith-Petersen (1939, 1948) all failed due to problems of attachment to the bone. The introduction of Charnley’s bone cements was celebrated as a “therapeutic breakthrough” (Schlegel, 1975). The impressive results of cement fixation were attributed to the large surface area made available for the transfer of loads: “Mechanical tests have shown an improvement of 200 times in the load-bearing capacity of the prosthesis compared to the condition without cement” (Charnley, 1970).

Study supported by the Deutsche Forschungs-emeinschaft, project DR 121/1