History of Hip Replacement — The Operation of the Century

Part of The Joint Replacement Guide — Phase 4: The Operation · Article 20 of 44 · Hip

Key Points

  • Modern total hip replacement is closely associated with the pioneering work of Sir John Charnley at Wrightington Hospital during the 1960s.
  • Charnley’s “low-friction arthroplasty” combined a small metal femoral head, an ultra-high-molecular-weight polyethylene socket and fixation using acrylic bone cement.
  • Total hip replacement has been described in The Lancet as “the operation of the century” because of its reliable ability to relieve pain and improve quality of life.[1]
  • National joint registries have become an important patient-safety tool by monitoring implants and surgical outcomes across large populations.

Before Charnley

Surgeons had attempted to treat severe hip arthritis long before the modern total hip replacement was developed. Earlier operations included removing or reshaping damaged bone, fusing the joint, and placing materials such as biological tissue, glass or metal between the worn joint surfaces. Early artificial femoral heads and metal-on-metal replacements were also developed during the first half of the twentieth century.

Some of these procedures helped selected patients, but their results were not consistently reliable or durable. Severe hip arthritis therefore remained a major cause of long-term pain and disability.

Sir John Charnley and Low-Friction Arthroplasty

Working at Wrightington Hospital in Lancashire, Sir John Charnley developed and refined the system that became the foundation of modern total hip replacement.

His concept was known as low-friction arthroplasty. It used a small metal femoral head—approximately 22 millimetres in diameter—to reduce frictional torque within the artificial joint. The head moved inside a plastic socket, while both components were secured using polymethylmethacrylate (PMMA), commonly called bone cement.[2]

Charnley initially used polytetrafluoroethylene (PTFE, commonly known as Teflon) for the socket. Unfortunately, this material wore rapidly inside the body and produced harmful tissue reactions. He subsequently adopted ultra-high-molecular-weight polyethylene (UHMWPE), which performed much better and became an established bearing material in hip replacement.[2,3]

Charnley did not invent every individual component or introduce the first ever artificial hip. His major achievement was bringing together implant design, low-friction bearing principles, reliable cemented fixation, surgical technique and infection prevention into a reproducible operation with durable results.

Why It Became Known as the “Operation of the Century”

In 2007, an influential review in The Lancet described total hip replacement as “the operation of the century.”[1] The description reflects the operation’s ability to provide substantial pain relief and improved mobility for many people with severe hip disease.

However, no operation guarantees a particular result. Outcomes depend on factors including the underlying diagnosis, general health, implant selection, surgical technique and the occurrence of complications. The phrase should therefore be understood as recognition of the procedure’s overall contribution to medicine, rather than a promise that every patient will have a perfect outcome.

How Hip Replacement Has Evolved

Modern hip replacements retain many of Charnley’s basic principles, but the implants and techniques have continued to develop. Important changes include:

  • improved polyethylene, including highly cross-linked polyethylene designed to reduce wear;
  • ceramic and modern metal femoral heads;
  • reliable uncemented implants that allow bone to grow onto or into their surfaces;
  • improvements in cementing technique and implant design;
  • larger femoral heads and dual-mobility bearings for selected patients;
  • improved infection prevention, anaesthesia and recovery pathways; and
  • computer navigation and robotic assistance in some hospitals.

Navigation and robotic systems may help surgeons plan the operation and position components more consistently in particular circumstances. Research is continuing, however, and they should not be assumed to produce better long-term outcomes for every patient or to replace the judgement and experience of the surgical team.

The Importance of Joint Registries

One of the most important developments since Charnley’s era has been the creation of national joint replacement registries.

The Swedish Hip Arthroplasty Register began in 1979 and was the first national quality register dedicated to hip replacement.[4] The National Joint Registry for England and Wales was established in 2002 and began collecting hip and knee replacement data in April 2003. It subsequently expanded to include additional joints and geographical areas.[5]

Registries collect information about procedures, implants, revisions and other outcomes across very large numbers of patients. This allows potential problems with particular implants, techniques or patterns of practice to be identified earlier than might be possible through individual hospitals or small clinical studies alone.

A registry signal does not, by itself, prove that an implant is defective or automatically result in its withdrawal. It provides evidence that can prompt closer investigation, regulatory review and changes in clinical practice where appropriate.

In More Depth

Charnley’s original replacement used a much smaller femoral head than many contemporary designs. The intention was to reduce frictional torque and the forces acting at the cemented fixation surfaces. Modern bearing materials have allowed surgeons to use larger heads in many patients, potentially improving stability and range of movement while maintaining acceptably low wear.

Today, both cemented and uncemented hip replacements can give excellent long-term results when appropriately selected and implanted. The most suitable combination depends on factors such as age, bone quality, anatomy, activity level, the implant’s established evidence and the surgeon’s experience.

The history of hip replacement is therefore not the story of one implant remaining unchanged. It is the story of Charnley’s core principles being tested, refined and monitored over time through laboratory research, clinical studies and national registry data.

This article provides general information and does not replace individual clinical advice. Implant choice and surgical technique should be discussed with your own surgical team.

References

  1. Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet. 2007;370(9597):1508–1519. doi: 10.1016/S0140-6736(07)60457-7.
  2. Wroblewski BM, Siney PD, Fleming PA. The Charnley hip replacement—43 years of clinical success. Acta Chir Orthop Traumatol Cech. 2006;73(1):6–9. PubMed PMID: 16613741.
  3. Charnley J. Arthroplasty of the hip: a new operation. Lancet. 1961;1(7187):1129–1132. doi: 10.1016/S0140-6736(61)92063-3.
  4. Swedish Arthroplasty Register. About the register and its history. Accessed 14 August 2026. Swedish Arthroplasty Register.
  5. National Joint Registry. About the NJR and timeline of registry data collection. Accessed 14 August 2026. National Joint Registry.

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