Hip replacement: the rise of cementless hips

Written by: Mr Godfrey Charnley
Published: | Updated: 21/10/2019
Edited by: Laura Burgess

Hip replacement is a procedure where the hip joint is replaced by a prosthetic implant, and is a very common orthopaedic operation. Hip replacement surgery was first performed in the 1930s. Almost a million hip replacements are performed now, worldwide, each year and the designs and ways of fixing the implants to the skeleton have changed, particularly over the past 20 years.

Here, one of our top orthopaedic surgeons Mr Godfrey Charnley describes how the cementless options have become used more widely, and the advantages of this.

What is the history of hip replacement?

In November 1962 Sir John Charnley, a pioneer of hip replacement surgery in the UK but also worldwide, implanted his first cemented total hip replacement. He fixed both the hip socket, (acetabular component) and the femoral stem with acrylic cement. This mode of fixation became the standard practice in the UK for 40 years.

What many people do not realise is that before this in the late 1950s, he tried a press-fit, cementless acetabular ‘Teflon’ component but these did not survive and he moved to a different way of fixing hips.

A decade or so later, other surgeons, particularly French surgeons, found alternative ways to fix hip components within the skeleton by using rough surface finishes or coatings to attract bone to adhere or grow onto the components. This is to achieve a more ‘biological’ fixation.
 

What are the differences between cemented and cementless hip replacements?

The 2019 National Joint Registry figures report that of over 100,000 hip replacements performed, 67,000 acetabular components were fixed without cement and over the same period, almost 40,000 femoral components were also cementless.

These numbers reflect a trend in the UK away from cemented to cementless fixation. This is due to better surface finishes and better biological coatings. The work from France has demonstrated that a calcium-based coating on the femoral components, ‘hydroxyapatite’, is very successful and I prefer for my acetabular components, a ‘trabecular metal’ – Tantalum surface finish.

This metal, microscopically, has a honeycomb lattice-like structure which bone cells recognise as being similar to their structure, enabling them to grow into the surface finish, giving an excellent fixation.
 

What are the advantages of a cementless hip replacement?

The benefits of modern cementless fixation are that they avoid the debris and inflammation associated with fragmentation and loosening of the bone cement in time. They also enable larger diameter bearings to be used than with cemented acetabular components, giving patients greater hip stability.

In my clinic, I routinely use the CORAIL Total Hip System®, which is a popular brand and design of stem with a hydroxyapatite coating. This bone-conserving option is designed for easy surgical installation. It was originally pioneered near Lyon in France and has a 30-year track record. It is the most commonly used stem not only in France and Europe but now in the UK.

The results of trabecular metal developed in the early 2000s in the United States of America have shown a dramatic improvement in survival of acetabular components in both primary and especially revision hip surgery.
 

Are there any drawbacks to having a cementless hip replacement?

The costs of cementless hips are more than those of cemented components. It is essential that surgeons pre-operatively plan and intra-operatively assess the stability of cementless components. This is to minimise the risk of subsidence or premature loosening.

 

Book an appointment with Mr Charnley if you would like to discuss your hip replacement options.

Mr Godfrey Charnley

By Mr Godfrey Charnley
Orthopaedic surgery

Mr Godfrey Charnley is a highly experienced consultant orthopaedic and trauma surgeon based in Essex, who specialises in hip and knee replacement surgery. He has almost 25 years of consultant experience in joint replacement surgery of the lower limbs.

Mr Charnley qualified from St Thomas’ Hospital in London in 1983 and received training as a registrar in London and as a senior registrar in Bristol. Before moving to Chelmsford in 2002, he was both a consultant orthopaedic surgeon and honorary senior lecturer in Derriford Hospital in Plymouth and at the Plymouth Post Graduate Medical School between 1995 and 2002.

At the hospital, he was the Lead Surgeon in Trauma and was Surgical Tutor for the Royal College of Surgeons of England. On the basis of his educational status there and subsequently in Chelmsford, in 2007 Mr Charnley achieved the status of the Fellow of the Higher Education Academy.

His private practice is at Springfield Hospital in Chelmsford. He has introduced to mid-Essex many new techniques in joint replacement surgery, including trabecular metal acetabular components, the CPT cemented stem system, the Corail cementless stem system, a minimally invasive anterolateral approach to the hip joint, and the Birmingham hip resurfacing.

Mr Charnley has been a Regional Clinical Co-ordinator for the National Joint Registry and was an examiner, for over 10 years, for the FRCS Orth examination.

Mr Charnley reviews papers for an international hip surgery journal on a regular basis and is also recognised as an expert witness, both by lawyers and NHS Trust legal departments, to give an opinion in cases of possible medical negligence in relation to hip and knee replacement surgery.


  • Related procedures
  • Platelet-rich plasma
    Ozone therapy
    Botulinum toxin (Botox™)
    Abnormal gait
    Elbow
    Epicondylitis (tennis elbow)
    Elbow Pain
    Nerve Compression elbow
    Median nerve compression
    Radial nerve compression
    This website uses our own and third-party Cookies to compile information with the aim of improving our services, to show you advertising related to your preferences as well analysing your browsing habits. You can change your settings HERE.