Hip replacement has been one of the most successful operations over the last three to four decades. It was felt to be the operation of the century by an author in 2007. We have seen an evolution from the original Charnley total hip in the 1960s, but his success with metal-on-polyethylene followed failed attempts with other bearing materials including metal-on-Teflon. In the 1970s and 1980s, we thought that we were seeing lesions in bones secondary to cement use in total hips, but as it turned out, the lesions in bone were due to polyethylene wear. We went through evolutions of polyethylene in the 1990s that did not work. We switched from cemented stems to cementless stems. These had some early failures, but ultimately, cementless fixation became the standard of care. In the early 2000s, work with ceramic, metal, and polyethylene evolved, and in 2015 the bearing of choice for hip replacement is either a metal or ceramic ball on a cross-linked polyethylene liner. This seems to have the highest predictability with the least number of complications.
It is important to note that innovation has always been integral to joint replacement. Partnerships between surgeons and the orthopedic industry have led to innovations that at times have been incremental and other times substantial and yet at other times transformative. It is important to remember that laboratory results do not always correlate closely with clinical results and that clinical results in the hands of experts may not be transferable into everyone’s hands. Innovation has allowed us to alleviate the pain associated with hip and knee disease in millions of patients worldwide.