The breakthrough idea, as often happens in medicine, was a revisitation
of an old concept. The first successful hip arthritis operations were
performed by Marius Smith-Petersen, chairman at Massachusetts General
Hospital, who had performed “cup arthroplasty” of the femoral head by
capping the femoral head with glass and metal cups. The mixed results of
cup arthroplasty were greatly surpassed by Charnley’s total hips, but the
problem of hip dislocations and polyethylene wear had inspired surgeons
and manufacturers to (again) consider replacing the head with a large
metal ball. Derek McMinn, an Irishman trained in London and practicing
in Birmingham, England, since 1988, thought about reincarnating the idea
of hip replacements without a polymer lining, as originally proposed by
McKee and Farrar in 1960.^15 McMinn began using (in 1991) a large
smooth metal head that rotated within a polished metal hip cup, hoping
that careful placement of the components would result in a thin layer of
fluid interposing itself in a self-lubricating fashion in between the metal
ball and metal cup.
Originally calling his hip the “McMinn Hip” in 1991, the intrepid
surgeon began in 1997 to use the newly designed “Birmingham Hip
Resurfacing” (BHR) implants. The early results were excellent, and the
allure of bone preservation (less bone is removed in BHR), greater hip
stability (because of a larger metal head), and lack of polyethylene wear
made the BHR a tempting alternative to regular hip replacement among
young, active patients. The timing of the BHR couldn’t have been better,
owing to the failures of the 3M Capital hip, which was removed from
European markets in the same year.
Derek McMinn published the early results of his Birmingham hip in the
British JBJS in 2004. At an average of 3.3 years from surgery, only one of
the original 440 patients had revision surgery, an astounding 99.8 percent
having avoided failure of their implant. By the year 2000, Mr. McMinn
was implanting over two hundred BHRs per year, and his secret was out.
The electricity in the air regarding a hip that could survive and not
dislocate energized engineers and surgeons in America and around the
world, and they scrambled to design a “metal-on-metal” (MoM) hip
replacement for themselves.
DePuy Orthopedics, based in tiny Warsaw, Indiana, is the oldest implant
manufacturing company in the world. DePuy was founded in 1895, and
was originally a splint manufacturing company before becoming an