Forty-year survival of a Judet hip prosthesis: a case report.

In 1946, the Judet brothers performed their first ‘resectionreconstruction’ of the femoral head (Judet 1947) using a prosthesis made entirely of polymethylmethacrylate (PMM.A). The early implants broke frequently and were later reinforced by a steel rod (Judet and Judet 1950). Failures continued, however, and use of the prosthesis was abandoned decades ago. Case report. In 1952, a 12-year-old girl had a Judet hip arthroplasty for degenerative changes secondary to congenital hip dislocation (Fig. 1). Seven years later she felt some pain and was told that the implant had migrated (Fig. 2), but she was then lost to follow-up. In 1984 she had total replacement of the opposite hip for pain greater than that in the loosened acrylic prosthesis (Fig. 3). connective tissue around the loose rod. Histological examination of the thickened capsule of the joint was reported to show degenerate and hyalinised scar tissue with mucoid and chondroid patterns, but no birefringent debris. The head ofthe implant was worn (Fig. 4) although intra-articular debris was neither obvious nor histologically detected. The patient had a good painless result after cementless revision. Discussion. Other very long-term results of hip replacement are rare. Joshi et al (1993) reported the 24-year survival of a Charnley-type prosthesis and Zaoussis and Patikas (1989) reported two McKee-type implants still in situ after 20 years. PMMA proved to be an inappropriate material for endoprostheses, although Rushton, Hart and