FAILED INNOVATION IN TOTAL HIP-REPLACEMENT - DIAGNOSIS AND PROPOSALS FOR A CURE

被引:173
作者
HUISKES, R [1 ]
机构
[1] UNIV NIJMEGEN, INST ORTHOPED, BIOMECH SECT, NIJMEGEN, NETHERLANDS
来源
ACTA ORTHOPAEDICA SCANDINAVICA | 1993年 / 64卷 / 06期
关键词
D O I
10.3109/17453679308994602
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Many new hip prostheses and fixation techniques have been introduced in orthopedics in recent years. Yet, none have provided superior total hip replacements (THR) in comparison to the traditional cemented Charnley concept, which nevertheless has limited long-term endurance. This review article investigates why the THR innovation process has failed. The predominant causes for long-term failure of THR are discussed. A framework of generic failure scenarios is proposed to provide guidelines for a scientifically-oriented approach to THR design, testing and clinical evaluation. It is shown that THR components are subject to incompatible design goals as regards prevention of the different failure scenarios. Neglect of those has been one important factor in the present innovation impasse. A second factor is the trial-and-error culture in orthopedic surgery, in which new devices run through the innovation cycle without proper testing or rigorous postoperative analysis. The third factor is ineffective regulation of marketing approval with respect to orthopedic implants. Scientific research in orthopedics and related sciences has produced new methods for systematic design evaluation, pre-clinical testing and clinical trials. These can provide a basis for self-regulation and self-control by the orthopedic community, in all stages of the innovation process.
引用
收藏
页码:699 / 716
页数:18
相关论文
共 56 条
[41]  
Robinson R P, 1989, J Arthroplasty, V4, P55, DOI 10.1016/S0883-5403(89)80054-3
[42]  
RYD L, 1992, CLIN ORTHOP RELAT R, V276, P55
[43]   WEAR OF THE POLYETHYLENE ACETABULAR CUP - METALLIC AND CERAMIC HEADS COMPARED IN A HIP SIMULATOR [J].
SAIKKO, VO ;
PAAVOLAINEN, PO ;
SLATIS, P .
ACTA ORTHOPAEDICA SCANDINAVICA, 1993, 64 (04) :391-402
[44]   WEAR OF POLYETHYLENE ACETABULAR CUPS AGAINST ALUMINA FEMORAL HEADS - 5 PROSTHESES COMPARED IN A HIP SIMULATOR FOR 35 MILLION WALKING CYCLES [J].
SAIKKO, VO .
ACTA ORTHOPAEDICA SCANDINAVICA, 1993, 64 (05) :507-512
[45]  
Sandborn P M, 1988, J Arthroplasty, V3, P337, DOI 10.1016/S0883-5403(88)80034-2
[46]   STAYING THE COURSE [J].
SARMIENTO, A .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 1991, 73A (04) :479-483
[47]  
SCHMALZRIED TP, 1992, CLIN ORTHOP RELAT R, P60
[48]   EXPERIMENTAL-METHOD FOR THE INVITRO TESTING OF THE INITIAL STABILITY OF CEMENTLESS HIP PROSTHESES [J].
SCHNEIDER, E ;
EULENBERGER, J ;
STEINER, W ;
WYDER, D ;
FRIEDMAN, RJ ;
PERREN, SM .
JOURNAL OF BIOMECHANICS, 1989, 22 (6-7) :735-744
[49]  
SELVIK G, 1989, ACTA ORTHOP SCAND S, V232
[50]   TISSUE INGROWTH INTO TITANIUM AND HYDROXYAPATITE-COATED IMPLANTS DURING STABLE AND UNSTABLE MECHANICAL CONDITIONS [J].
SOBALLE, K ;
HANSEN, ES ;
RASMUSSEN, HB ;
JORGENSEN, PH ;
BUNGER, C .
JOURNAL OF ORTHOPAEDIC RESEARCH, 1992, 10 (02) :285-299