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My new role is exposing me to the rich history the UK has in medical innovation...
As some of you may know, our tiny island has given rise to many life-changing medical innovations. It has now been 60 years since Charnley first pioneered modern total hip replacement and spent the next two decades refining all aspects of the procedure.
More than 1 million total hip replacements are now performed each year worldwide, and the procedure has been noted as the “operation of the century” ¹. Understandably, this is Charnley’s most notable and well-known development.
However, would you be surprised if I said Charnley was the first to develop a total hip “Resurfacing”? Recently I attended the Bristol Hip Meeting, where I found myself in conversation with an orthopaedic fellow, who couldn’t quite grasp what I was saying when I mentioned Charnley’s 1951 development and simply didn’t believe there was a connection between Sir John Charnley and Hip Resurfacing.
Why is this so hard to believe? and more so, why isn’t the full history behind all of Charnley’s developments discussed and taught more widely?
In the early 1950s, the concept of a double cup arthroplasty was introduced in which both the femur and acetabulum were fitted with articulating prostheses. Charnley was the first to develop a total hip resurfacing system of this nature using Teflon as the bearing material.
The use of concentric shells of Teflon was short-lived, owing to the overwhelming failure of these devices. Later, Charnley used the Teflon material as an acetabular bearing surface in the earliest versions of his low-frictional torque total hip replacements.
Charnley’s first instinct when looking to treat patients with debilitating hip disease was to explore a Hip Resurfacing procedure. It was unfortunate that the materials employed in this attempt did not deliver the results Sir John expected...
In my opinion, developments surrounding hip resurfacing would have contributed significantly to the evolution of Charnley’s modern total hip arthroplasty that we know of today.
I ask if the materials and fixation methods employed by Charnley during his Hip Resurfacing phase had proved to be more dependable, what would the global hip replacement market look like today?
References:
1: Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet. 2007 Oct 27;370(9597):1508-19. doi: 10.1016/S0140-6736(07)60457-7. PMID: 17964352.