As is probably the case with all successful innovations, the unique design of the thrust plate prosthesis (TPP) was not born of a sudden fancy for a radically different hip joint replacement, but emerged from elaborate biomechanical investigations on the loosening of conventional, intramedullarly anchored hip prosthesis shafts. In the 1970s, hip revisions due to loosening of the prostheses became a burden to patients not only physically and psychologically but also economically. This meant that it also became a matter of daily concern to the orthopaedic surgeon, who then had to cope with new, previously unknown problems. Loosening processes were de tected within 5 years of implantation in up to 25% of cases. While implant loosenings were considered to be the result of incorrect handling of materials, we felt that a number of details still had to be considered in regard to the behavior of the entire bone-prosthesis complex and the action of mechanical forces.
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The thrust plate prosthesis is a new type of hip prosthesis which maintains the physiological loading pattern of the bone. Experimental stress analysis of the proximal femur led to the development of this device, and clinical results over a period of more than 12 years confirm the sound biomechanical concept on which it is based. Conventional prostheses of the stem type are still prone to loosening and subsequent revision operations which are surgically particularly demanding. The thrust plate prosthesis, in contrast, allows a revision procedure, if at all necessary, to be performed with the same ease as a primary implantation. This, together with the fact that bone stock is preserved, makes it especially attractive for use in physiologically active and young patients. More than 150 figures, 16 of which are in colour, illustrate details in the development of the device and the clinical observations made by a group of participants in a pilot study. This book introduces the thrust plate prosthesis in detail to the hip surgeon. It is an accurate account of the long and laborious effort involved in realizing a project that was born out of critical observations.
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