50 Years Ago in CORR: Complications in Replacement Arthroplasty of the Hip; Experience with 68 Additional Cases Howard Mendelsohn, MD and Bernard N. Becker, MD CORR 1955;6:48–53

This month’s symposium is devoted to complications in total joint arthroplasty. Surgeons have always been concerned about complications of their operations, and arthroplasty is no exception. Arthroplasty arises from two Greek words, arthros meaning joint and plastikos related to molding. The concept has been attributed to John Rhea Barton of Philadelphia, who osteotomized the upper end of the femur of a patient with a spontaneous joint fusion, and by moving the osteotomy site created a mobile yet stable pseudarthrosis [2]. However, subsequent investigators in the late 1800s and early 1900s used an innovative array of approaches, primarily by inserting foreign materials between the joint surfaces [1, 7]. Smith-Petersen introduced the use a Vitallium cup between the acetabulum and femoral head in the 1930s, undoubtedly achieved greater success than earlier investigators [8, 9]. Perhaps the first attempt to actually replace both joint surfaces was that of Themistocles Gluck, who in 1894 described his efforts to fashion joint surfaces from ivory [7], but he reported no followup. Later authors, including Moore [6] and Thompson [10] used metal to replace only one side of the joint (hemiarthroplasty). The earliest successful attempts to replace both sides of the joint were reported by Charnley in 1961 [3] and McKee and Watson-Farrar in 1965 [11]. All reported complications, including those reported by Charnley: the disastrous wear of Teflon as a bearing material [4] and high infection rates [5]. Mendelsohn and Becker reported high complication rates using hemiarthroplasty, including deaths in 12 of 66 patients (18%) (Table 2). One hundred fourteen other mostly major complications occurred in 53 of the 66 patients. These included migration and erosion of bone (Fig. 5). They concluded, “It is not our intention to evaluate preoperative indications, but, in view of the dismal picture portrayed by this statistical survey, it is our strong clinical impression that this operation should be regarded as a procedure of last resort for carefully selected patients in the older-age group.” All of these early pioneers and users of these various sorts of approaches had high complication rates. Had they not persisted, we would not have today what is undoubtedly one of the most effective operations ever developed for relieving pain and restoring function: total hip arthroplasty has relieved and enhanced the quality of life for millions of patients worldwide. If complications occur far less commonly today, and if the very large majority of patients (over 90%) retain excellent function for ten years or more, complications for those unfortunate few who develop them remain a major challenge for the patients and for their doctors. Table 2 Fig. 5 Eicher prosthesis. (Left) Three months after operation. The prosthetic head has migrated superiorly and does not articulate with the acetabular fossa. (Right) Twenty-one months later, showing creation of a secondary acetabular fossa with progressive superior ...