Over 25 years survival after Charnley's total hip arthroplasty.
BACKGROUND
Since 1962, the low friction arthroplasty (LFA) developed by Sir John Charnley has spread widely throughout the world. Many series have reported long-term results. Polyethylene (PE) wear is well known. The average wear ratio is about 0.1 mm a year. Many factors may influence that wear process.


OBJECTIVE
The authors describe two different series of patients operated upon with Charnley's total hip arthroplasty (THA) using the original cemented stem and a non modular 22.2-mm head, with a cemented full polyethylene acetabular socket. Outcomes confirm excellent patient function after 25 years. They emphasise the fact that PE is the weak point of total hip arthroplasty. Function may be excellent even though PE wear is significant. In several cases, no wear at the maximum follow-up was detectable.


RESULTS
This study confirms different publications relating long-term follow-up with LFA. During a Charnley meeting in Lyon, we published a survival curve of 85% after 25 years. Berry et al. published a 86.5% survival curve (J Bone Joint Surg Am 84:171-177, 2002). In 1995, Luc and Marcel Kerboul published a 77% survival rate after 20 years in young patients under 40 years old at the time of the surgery. In 2009, Callaghan et al. published a series of 35 years follow-up with a ratio of 78% survivorship (J Bone Joint Surg Br 91:2617-2621).


CONCLUSIONS
Could the long-term results be improved? Through recent decades, many solutions have been introduced to improve the survivorship of THA including bearing surfaces such as alumina-on-alumina and metal-on-metal. Different problems have occurred with these solutions. LFA might be improved by working on the nature and the quality of the head. Improvements might also be obtained by working on the quality and the hardness of the acetabular socket.
Clinique Emilie De Vialar, 116 Rue Antoine Charial, 69003 Lyon, France.
Jacques
J
Caton
Jean Louis
JL
Prudhon
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D002484:Cementation; D005260:Female; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D006622:Hip Prosthesis; D006801:Humans; D007592:Joint Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D059012:Lost to Follow-Up; D008297:Male; D008875:Middle Aged; D020959:Polyethylene; D011183:Postoperative Complications; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies
D020959:Polyethylene
J Bone Joint Surg Am. 2002 Feb;84(2):171-7
11861721
J Bone Joint Surg Br. 2007 Aug;89(8):1015-8
17785737
J Bone Joint Surg Br. 2007 Nov;89(11):1439-45
17998178
J Bone Joint Surg Am. 2009 Nov;91(11):2617-21
19884436