The current status of total joint replacement.

The last two decades have witnessed tremendous strides in the evolution of acceptable and successful methods of prosthetic replacement for the arthritic joint. By and large, these techniques are predictable and durable, though not always to the complete satisfaction of the patient and surgeon. Despite the recent emphasis on alternative forms of implant fixation, cemented total joint replacements remain the standard by which all others are judged. In some settings, non-cemented implants appear to function as well as cemented ones in providing pain relief. The acetabular component in the hip and the femoral component in knee replacement are two such areas. This has resulted in the emergence of the "hybrid" joint replacement where one component is cemented while the other is not. The long-term function and durability of these non-cemented components remains to be seen. The future of joint replacement lies in the development of new "composite" materials which can more closely match the structural characteristics of the bone into which they are being implanted. Until we better understand and are able to prevent the disease processes which lead to total joint replacement, this area will continue to be the focus of intense research and development.