History of Artificial Joints
Copyright 2010. PEER.tamu.edu
Question:
• Do you know anyone that has ever had a
joint replacement surgery?
• Many people are now benefitting from joint
replacement surgery.
• Pets also benefit from joint replacement
surgery!
Hip Replacement
• The hip joint is the largest load
bearing joint. A hip joint is lined
with a layer of cartilage that reduces
friction and acts as a shock
absorber.
• When the bone is exposed to
arthritis and injury, this protective
layer is damaged, causing extreme
pain.
• What are some things that could
cause injury to your hip?
Hip Replacement
• The search to alleviate pain led surgeons
over a century ago to research the
possibility of hip replacements.
Early Hip Arthritis Surgery in the
1800s
• In 1821, Anthony White
of the Westminster
Hospital in London,
performed the first
anthroplasty, where an
arthritic or joint surface is
replaced. The procedure
helped with pain and
mobility, but failed with
stability.
Early Hip Arthritis Surgery in the
1800s
• In 1826, John Rhea Bartonii performed
the first osteomy, where a bone is cut
to shorten, lengthen, or change its
alignment. Unfortunately, this
procedure had unpredictable results.
• Early solutions also included removing
calcium deposits and damaged
cartilage.
Leading the Way
In 1891, Professor
Themistocles Glück led the
way in his development of a
hip implant fixation. He
produced an ivory ball and
socket joint that he fixed to
bone with nickel plated screws.
He also used a mixture of
plaster of Paris, and powdered
pumice with resin for fixation.
Glück Introduces New Ideas to
Studies
• Glück‘s studies on hip replacements led to greater
advancements that were implemented on other
joints, including knee joints.
• He was also one of the first to propose
implementing joints from corpses and amputated
limbs . He proposed the idea by demonstrating in
animal experiments that the cavity in the bone for
the bone marrow would accept the shaft of the
artificial joint if it is stably anchored within it.
Glück Introduces New Ideas to
Studies
• Glück was also a pioneer in proposing
the idea of biocompatibility, which
explains how a foreign material placed
in the body must be well tolerated by
the patient’s body.
Think Break:
• What were some of the problems with early
efforts at joint replacement?
• What were some of the materials used in
early joint replacement surgeries?
Greater Advances
• In 1925, a surgeon in Boston, Massachusetts,
M.N. Smith-Petersen, M.D., molded a piece of
glass into the shape of a hollow hemisphere
which could fit over the ball of the hip joint
and provide a new smooth surface for
movement.
While proving biocompatibility, the glass could
not withstand the stress of walking and
quickly failed.
Greater Advances
• One concern in prosthetics is using a
material that is biocompatible and will
not cause adverse effects once implanted,
an idea Glück had introduced earlier.
• M.N. Smith-Peterson continued his
studies and pursued other materials
including plastic and stainless steel.
Cobalt-Chromium Alloy
• A dramatic improvement was
made in 1936 when scientists
manufactured a cobalt-chromium
alloy. This new alloy was both
very strong and resistant to
corrosion, and is still being used
today.
• While this new metal proved to
be a great success, the actual
resurfacing technique was not
adequate.
What is Hip Resurfacing?
Hip resurfacing involves removing the
cartilage from the surface of the femoral
head and replacing it with a metal cap. This
may save the hip joint for 20 to 30 years.
Finding a solution…
• In 1938, Dr. Jean Judet and his
brother, Dr. Robert Judet, of
Paris, attempted to use an
acrylic material to replace
arthritic hip surfaces.
Unfortunately, this material fell
short of expectations and tended
to fall loose.

Judet acrylic prosthetic design
By this time it became clear that artificial joint
material had to be biocompatible and withstand
the stresses of the body.
Continuing Research
• In the 1950s, Frederick R. Thompson and
Austin T. Moore separately developed
replacements for the entire ball of the hip.
Continuing Research
• Their type of hip replacement replaced
the arthritic femoral head (ball), but
failed to replace the acetabulum (hip
socket).
• The prosthesis consisted of a metal stem
which was placed into the marrow cavity
of the femur, connected in one piece with
a metal ball which fit into the hip socket.
The Birth of “Total Hip
Replacement”
• In 1958, John Charnley
from England introduced
the idea of replacing the
eroded arthritic socket
with a Teflon component.
When this failed he used
a polyethylene polymer to
construct the socket.
Charnley replaced Teflon with
polyethylene
The Birth of “Total Hip
Replacement”
• To obtain fixation of the polyethylene
socket as well as the femoral implant to
the bone, polymethylmethacrylate was
used as a bone cement.
• By 1961, Charnley was performing
surgery regularly with great results.
Animal Studies
• J. Charnley did not come across his
innovations by pure luck. He became highly
interested in animal studies and applied these
findings to the design of hip replacement.
• In particular, Charnley did research in the
lubrication of animal joints after a patient with
a Judet replacement produced a squeak when
he moved his hip.
Animal Studies
• He studied the work of biologists who studied
lubrication of animal joints. This helped Charnley
explain why synovial (joint) fluid served as a
lubricant for articular (joint) cartilage, but not for
metal on bare bone, nor a lubricant for metal on
metal.
Hip Dysplasia in Dogs
Normal Hip
Abnormal Hip
The left image is a normal hip. The femur is
smooth and round. The ball fits nicely into
the socket (acetabulum).
The right image is a abnormal hip. We can
see a shallow socket and a short neck
attaching the ball to the shaft of the femur.
Hip Dysplasia Treatment
Total hip replacement in canines results in the
most normal limb function in large dogs. The
objective of this procedure is to replace the
cartilage of the acetabulum “socket” with a
polyethylene socket, and the femoral head with
a metal prosthesis.
Stop and Think:
• What are some good reasons why
researchers use animals as subjects in their
investigations?
Knee Replacement
• The healthy knee joint is lined with cartilage.
Arthritis and injury can cause damage to this
protective layer.

The damage of knee joints by arthritis
led to research and development of
knee replacements.
Knee Replacements

The study of hip
replacements led to
ways to treat knee joints.
• Some of the early work
began by implanting metal
spacers between the bones
of the knee. In the 1950s,
McKeever and McIntosh
attempted this procedure but
results were unpredictable.
The Beginning of Knee
Replacements
During the late 1960's, a
Canadian orthopedist, Frank
Gunston, from Sir John
Charnley's Hip Center,
developed a metal-on-plastic
knee replacement to be secured
to the bone with cement. This
was really the first metal and
plastic knee and the first with
cement fixation.
Continued Advancements
• In 1972, John Insall, M.D., designed what has
become the prototype for current total knee
replacements.

The prosthesis was made
of three components for
resurfacing all three
surfaces of the knee -the
femur, tibia and patella
(kneecap). Each were
fixed with bone cement
and the results were
outstanding.
Leading Vendors
• Moore’s 1952 model was produced in
collaboration with Howmedica Inc., at the
time Austenal Laboratories, now merged
with Stryker®.
• Stryker® is one of the leading medical
device companies today.
• Encore medical is also one of the leading
medical device companies that led the way
in prosthetic hip and knee replacements.
Stryker Products
Hip Replacement Systems
Primary Acetabular
Components
Primary Femoral
Components
3-D Knee
Knee Replacement
Joint Replacement Today
Joint replacements have come a long way
since their beginning. Every year, more than
600,000 people in the U.S. undergo hip- or
knee-replacement surgery, according to
Consumer Reports.
New advancements in hip replacement include
minimally invasive surgery that spares
muscle, offering patients a faster recovery.
The Future????
• What can you imagine for the
future of Joint Replacement?