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Charnley Low-Frictional Torque Arthroplasty of the Hip

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Charnley Low-Frictional Torque Arthroplasty of the Hip Charnley Low-Frictional Torque Arthroplasty of the Hip B.M. Wroblewski • Paul D. Siney Patricia A. Fleming Charnley Low-Frictional Torque Arthroplasty of the Hip Practice and Results B.M. Wroblewski Patricia A. Fleming The John Charnley Research Institute The John Charnley Research Institute Wrightington Hospital Wrightington Hosptial Wigan , Lancashire Wigan , Lancashire UK U K Paul D. Siney The John Charnley Research Institute Wrightington Hospital Wigan , Lancashire UK ISBN 978-3-319-21319-4 ISBN 978-3-319-21320-0 (eBook) DOI 10.1007/978-3-319-21320-0 Library of Congress Control Number: 2016934314 Springer Cham Heidelberg New York Dordrecht London © Springer International Publishing Switzerland 2016 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper Springer International Publishing AG Switzerland is part of Springer Science+Business Media (www.springer.com) Foreword by Lady Charnley At the time of Sir John’s death in 1982, the Charnley low-friction arthroplasty for hip replacement was accepted as a great breakthrough and successful operation for patients suffering from arthritic hips. The procedure was not without its critics and the team, under the leadership of Professor Wroblewski, have carefully evaluated the results and problems over the years. They are to be congratulated for producing a book which will be invaluable to orthopaedic surgeons who seek to understand the underlying philosophy of the Charnley LFA. Lady Charnley President The John Charnley Trust McMillan & Co LLP Chorley, Lancashire UK v Foreword by Charnley Research Institute Fifteen of the Fellows were from the UK and Ireland, John Hodgkinson, David Allen, David Beverland, Anthony Browne, Martin Stone, Shiv Gupta, Peter Kay, Videsh Raut, Mike Manning, Anthony Clayson, Eric Gardner, Roger Tillman, Chris Walker, Keith Barnes and Andrew Phillipson. Four Fellows were from Europe, Blaise Wyssa, Rabih Makarem, Peter Bobak and Bodo Purbach. Two Fellows were from North and South America, Alberto Dominguez and Major Greg Taylor. Three Fellows were from Australia, Julian Lane, Scott Crawford and David Mitchell. The last Fellow Hagime Nagai from Japan completed his fellowship in 2002. Scott Crawford and Hajime Nagai had followed their respective fathers, Bill Crawford and Jun Nagai, who had both worked with Charnley at Wrightington in the 1960s. vii Foreword John Charnley’s scientifi c development of the modern, successful, total hip arthroplasty must be considered one of medicine’s greatest achievements in the twentieth century. His low-frictional torque arthroplasty has demonstrated endur- ing success since 1962 and established a turning point in orthopaedic surgery, from fractures and deformity to a discipline that offers some of the technically most chal- lenging operations on almost all joints. The operation has helped many thousands of patients all over the world to carry on with life in a way that was previously unthinkable. It was Charnley’s well- calculated expectation that the replacement of the human hip joint could last up to 25 years. Today, it is possible to study the effect of joint replacements on the human skeleton up to 50 years. It has always been Charnley’s understanding that the artifi - cial replacement would fail eventually either because of wear in the bearing or fail- ure of fi xation within the skeleton. These changes can be anticipated but need to be monitored by long-term review. The evaluation of long-term success – and failure – goes beyond a single sur- geons’ working-life experience, and it now befalls on the third generation of surgeons after Charnley to learn from the knowledge gathered over the last 50 years. Charnley established an apprenticeship-like teaching method, allowing surgeons worldwide to visit Wrightington and then disseminate the highly successful operation worldwide. The principles of Charnley’s operation remain crucial to its long- term success, an approach to the hip using a trochanteric osteotomy, fi xation and uniform load transfer using bone cement and a hard on soft small bearing to reduce the frictional torque on the fi xation within the skeleton. The improvement of the operation has been the pur- pose and achievement of Professor Mike Wroblewski, the surgeon to continue with the evolution of Charnley’s operation, principles and philosophy. It is the culmination of these achievements that is presented here, not as a success story that praises the results of the past but in the spirit of Professor Sir John Charnley, to foster a modern understanding of successful and failing designs of the artifi cial hip. From the experience at Wrightington, the success of the hip replacement does not primarily rely on materials, but on the principles of the operation and the skill and technique of the surgeon. ix x Foreword This instructive and precise manual will most likely endure, if the bias in trends of modern and fashionable orthopaedics is replaced with a wish for a better under- standing of success for the next generation of surgeons. Bodo Purbach MD Consultant Orthopaedic Surgeon Centre for Hip Surgery Wrightington Hospital UK Pref ace Photograph taken in 1970 of Professor Sir John Charnley in discussion with visiting surgeons in the operating theatre at Wrightington Hospital. The purpose of this work is to offer a better understanding of the Charnley low- frictional torque arthroplasty of the hip: based on over 50 years of clinical experience. xi xii Preface The underlying principles and their practical application, evolution in the light of clinical experience, radiographic appearances and the examination of explanted components are all an integral part of that process. Changes in the design, surgical technique and even the materials were dictated by the detailed study of all aspects of the procedure and follow-up. Radical departures from the principles were never part of that process. We have remained faithful to the concept of low-frictional torque – the small diameter (22.225 mm) head of the femoral component articulat- ing with a thick ultrahigh molecular weight polyethylene (UHMWPE) cup, both components grouted with cold curing acrylic cement polymethyl methacrylate (PMMA). Exposure of the hip by trochanteric osteotomy has remained the method of choice. Charnley, unfortunately, did not live to see the 20-year clinical results. In November 2012 we, here at Wrightington Hospital, have seen the 50-year milestone of the clinical application of the Charnley method. With the availability of long- term successes, and failures, it was, and still is, possible to focus attention on the various aspects of the operation, identify the problems and introduce changes accordingly. It is through the knowledge of the past and the understanding of the present that we can aim to achieve even better results for the future. We hope that this record of the continuing evolution of the Charnley low- frictional torque arthroplasty (LFTA) – (more commonly known as low-friction arthroplasty, LFA) – will help the newcomer to the speciality to appreciate the rea- sons for the success of the operation, while the experienced members will use it a stepping stone for further improvement without the trauma of past experiences. Wrightington , Lancashire , UK B. M. Wroblewski Wrightington, Lancashire, UK Paul D. Siney Wrightington, Lancashire, UK Patricia A. Fleming “ The challenge comes when patients between 45 and 50 years of age are considered for the opera- tion because then every advance in the technical details must be used if there is to be a reasonable chance of 20 or more years of trouble free activity”. “It is not in a young patient’s interest for a surgeon to count on a successful ‘revision’ should mechanical failure ensue earlier than was expected”. Charnley 1979 xiii Acknowledgements When attempting to express thanks, any author faces a dilemma of “attempting to name them all” and the “fear of omitting some”. No such problems here. The late Mr Peter Kershaw of the Peter Kershaw Trust made the concept of the John Charnley Research Institute a reality. It continues to function and expand thanks to the unfailing support of the Trust. To Lady Charnley, who through the John Charnley Trust gave practical and moral support. To the fellows who became involved in this work, often at an inconvenience to their families. To Mr Frank Brown, who worked in the Bio-Mechanical Laboratory for 40 years and with his practical knowledge of engineering and tool- making made instruments, modifi ed implants and made prototypes, often from a rough sketch or even a discus- sion, as drawings, in the strict sense of the word, were never made. To my secretary Brenda Lowerson, who after many years of hard work continued well beyond her duty often to the exclusion of her favourite golf. Individuals who made specifi c contributions are acknowledged in the appropri- ate chapters. To members of our families for their patience, understanding and support.
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