Current concepts in total hip arthroplasty

In the past six decades total hip arthroplasty has undergone dramatic developments and has proven to be one of the safest and most successful surgical procedures in orthopaedics. With the large number of surgeries in Germany this operation also contributes a significant economic impact to the budget of many hospitals. Meanwhile the patient's expectations have also increased in parallel with the increased number of procedures. Cemented prostheses remain the standard and show a long survival time with which the various non-cemented systems have to stand in comparison. The advantages of the cement-free prosthetic systems lie above all in their better biology, and recent developments in this issue favour short shafts. Progress has also been made in tribology. The new ceramics are markedly more stable and have the advantage of lower and inert wear particles in comparison to the metalon-metal systems. At the same time the hip resurfacing has lost the importance it had years ago. Less invasive surgical techniques enable a more rapid rehabilitation, but as yet a long-lasting advantage has not been demonstrated. In parallel to the increasing number of implantations of primary THA, the incidence of revision surgery and periprosthetic fracture is also increasing and will be a challenge for the future.