Comment on the Classics

The three papers reprinted here illustrate their authors’ efforts to address the problems of acetabular fixators and wear in total hip arthroplasty. Ring devised a technique to fix the acetabular component by using a long bolt inserted into the posterior ileum. Breck’s attempted solution consisted of the use of an Urist socket secured with multiple spikes and a flanged perimeter. The Ring and Breck systems use a metal-on-metal articulation. Bateman’s device essentially abandoned acetabular fixation and relied on a completely mobile head snapped onto the femoral head component and secured with intramedullary fixation. The two bearing surfaces (acetabular cup and femoral head) articulated with polyethylene above and metal below. Interestingly, all the authors de-emphasized the importance of cement fixation. Ring did not mention it and Bateman and Breck only used it occasionally on the femoral side.