Total hip arthroplasty in France

The Total Hip Arthroplasty (THA) is one of the most common surgical procedures and steadily growing.The first THA was designed by Mac Kee in 1941. Robert and Jean Judet have, in France, in 1946, performed the first series of total hip replacement in acrylic on patients.The modern THA has been developed by Sir John Charnley in 1962, 50 years ago.In 2010, the number of THA, in France, was estimated at 147513 by a national agency, Agence technique de l’Information sur l’hospitalisation (ATIH), with a revision rate of 11.17 % (16446 revisions). In France, the number of THA per inhabitant of 226.4/100000 is roughly the same that in all countries of Western Europe (Germany, England...). The very long-term results are more consistent, especially for the Charnley THA: 85% survival at 25 years (J Caton, Lyon ; J Older England ; D Berry, Mayo Clinic), 78 % at 35 years (JJ Callaghan, Iowa City), 72 % for the femoral implant and 53.7 % for Polyethylene cup (PE) for M Wroblewski after 38 years.These long-term results are weighted according to subject age and sex.Because of the aging population (in 2060 there will be more than 200000 people aged aver 100 years), we can expect an increase in femoral neck fractures and therefore THA.The medical risks of this intervention is low (0.33% mortality) and 5% of serious medical complications, most (40%) having a thrombœmbolic origin for which prevention is now well organized.The descriptive study of THA must consider bearing (metal PE – C/C-M/M or C/PE). The long-term complications are due to wear or fragile materials. The descriptive study should also consider the types of implants, their character (cemented or fixed without cement with or without HA coating), and possible conflicts due to the diameter of the femoral head or neck (IMPINGEMENT). New materials such as highly crosslinked PE (XLPE) or with vitamin E should be evaluated and their results compared to long-term gold standard represented by Charnley total hip replacement whose decline is now over thirty years.