The Hip - Principles of Human Joint Replacement - page 253

The fourth generation yielded some conceptual improvements, but not
apparently in long term use. Even in the short term fourth generation, biologically
fixed devices such as the AML had significant problems such as thigh pain which
are much less prevalent in cemented, third generation designs [163].
Knowledge about these earlier designs, technical advances and careful analysis
of their performance allowed the development of a fifth generation. This effort
produced improved performance of hip systems making them comparable to most
total knee replacements as shown by the survival analysis in Fig. 5.74.
Still the longevity of the fifth generation design is inferior to the better mobile
bearing knee designs. An improvement in the wear properties of the materials
used must be made to attain the same performance as the best knee replacements
[164]. Hopefully potential solutions, such as highly cross-linked UHMWPe or
improved ceramics, will provide such improvement.
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