Towards a Working Methodology for Using Total Hip and Knee Joint Replacements to Support Identification

Research Article

Austin J Forensic Sci Criminol. 2015;2(3): 1026.

Towards a Working Methodology for Using Total Hip and Knee Joint Replacements to Support Identification

Bryson D*

Department of Forensic Science, College of Life and Natural Sciences, University of Derby, Kedleston Road, Derby, DE22 1GB, United Kingdom

*Corresponding author: Department of Forensic Science, College of Life and Natural Sciences, University of Derby, Derby, United Kingdom

Received: May 12, 2015; Accepted: June 12, 2015; Published: June 29, 2015


Hip and knee prostheses have occasionally been used to support identification of unknown persons along with other medical devices and implants. This paper looks at the specific issues around using hip and knee implants, suggesting a working methodology for their use in supporting identification during and after a post-mortem.

The value of Total Knee Replacements (TKR) and Total Hip Replacements (THR) as a means of identification along with other implants is a very recent area of interest in Forensic Science considering the long history of implants. This together with the recent introduction of Joint Replacement Registries means that using hip and knee implants to support identification is likely to become automatic in the future but is not currently automatic.

The paper looks at the accumulative collection of evidence as well as the range of issues including; the types and changes in early prostheses, examination of the body for external indications of implants, radiological recording prior to autopsy for confirmation of identification using matching of features with ante-mortem images, actual harvesting and collection of all parts of the joint replacement including cement and any other components, specific differences between TKR and THR.

In developing an approach to the problems associated with identifications using TKRs and THRs a stepwise process and the full recording of all of the features associated with the implant as well as manufacturers details and identification numbers is suggested so that the cumulative nature of these features will help to narrow down possibilities towards a more certain identification and confirmation of that identification.

Keywords: Hip; Knee; Identification; Joint; Replacement; Autopsy


AJRR: American Joint Replacement Registry; NHS: National Health Service; NJR: National Joint Registry for England and Wales; THR: Total Hip Replacements; TKR: Total Knee Replacements; UK: United Kingdom


The use of implants to support identification has been described in the literature in general for example [1,2], and as individual cases reporting on the positive identification of burnt remains from an automobile accident based on a bone healing stimulator [3], using a tibial plate [4], using a femoral plate [5], using hip replacement radiographs after a car accident [6] and a partially mummified woman [7] and from implants and hip prostheses in the Tri-State Crematorium incident [8] the use of metal screws in heavily disrupted human remains [9].

This paper outlines a working methodology for using hip and knee joint implants which can;

In 2007 the National Joint Registry for England and Wales (NJR) recorded 68,950 hip procedures and 72,480 knee replacement procedures, these figures include revisions or re-operations (2008). These are the most useful of the implants as Clarkson comments ‘the usefulness of an implanted device in determining identity depends on the ability to associate that item to an individual’ (2007) and these two procedures have been compulsorily part of a data collection procedure in the United Kingdom (UK) since April 2003.

Historically hip joint replacements have been around for longer than knee replacements, see Table 1 developed from Scales paper on the history of hip replacements (1966) summarizing some of the changes in types of hip replacement. The number of people having joint replacements has steadily increased with the availability of modern surgical techniques but even reports on early operations, prospective studies, are looking at patient numbers in the high hundreds. Judet reported on 400 cases in 1952 and in 1955 Aufranc reported on 1,000 cases of hip arthroplasty over a 15 year period [10].