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Current thoughts on total hip replacement.

Opinion leaders in the field of total hip arthroplasty express antipodal views with bewildering frequency. New trends notwithstanding, Charnley low-friction arthroplasty has a record of outstanding success, and we should attempt to identify specific problems, and address these accordingly. Biological and biomechanical matching remain important and increased attention to meticulous cement technique should favourably improve the long-term performance of cemented implants. The concept of cementless replacement should not, however, be summarily discarded, particularly for the younger patient. The discovery of existing design limitations should lead to further development based on sound scientific research. In an era of exploding technology, cost-containment must remain a pragmatic reality in the provision of a health-care service to the community. At this stage we would recommend a cementless hip replacement for the very young, hybrid replacement (cemented stem, uncemented cup) for the middle-aged and a fully cemented replacement for the elderly.