EARLY DEVELOPMENT OF TOTAL HIP REPLACEMENT The transcript of a Witness Seminar held by the Wellcome Trust Centre for the History of Medicine at UCL, London, on 14 March 2006 Edited by L A Reynolds and E M Tansey Volume 29 2006 ©The Trustee of the Wellcome Trust, London, 2007 First published by the Wellcome Trust Centre for the History of Medicine at UCL, 2007 The Wellcome Trust Centre for the History of Medicine at UCL is funded by the Wellcome Trust, which is a registered charity, no. 210183. ISBN 978 085484 111 0 All volumes are freely available online at: www.history.qmul.ac.uk/research/modbiomed/wellcome_witnesses/ Please cite as: Reynolds L A, Tansey E M. (eds) (2007) Early Development of Total Hip Replacement. Wellcome Witnesses to Twentieth Century Medicine, vol. 29. London: Wellcome Trust Centre for the History of Medicine at UCL. CONTENTS Illustrations and credits v Abbreviations ix Witness Seminars: Meetings and publications; Acknowledgements E M Tansey and L A Reynolds xi Introduction Francis Neary and John Pickstone xxv Transcript Edited by L A Reynolds and E M Tansey 1 Appendix 1 Notes on materials by Professor Alan Swanson 95 Appendix 2 Surgical implant material standards by Mr Victor Wheble 97 Appendix 3 Selected prosthetic hips 101 References 107 Biographical notes 133 Glossary 147 Index 155 ILLUSTRATIONS AND CREDITS Figure 1 Site of a total hip transplant. Illustration provided by Ms Clare Darrah. 4 Figure 2 Mr Philip Wiles FRCS, c. 1950. Illustration provided by Sir Rodney Sweetnam. 5 Figure 3 X-ray of Wiles’ hip, c. 1950s. Illustration provided by Sir Rodney Sweetnam. 6 Figure 4 Charnley PTFE double cup implant, c. 1960. Illustration provided by the John Charnley Trust. 7 Figure 5 The Ring total hip replacement: X-ray of THR in position, 1970. Illustration provided by Mr Peter Ring. 8 Figure 6 Ken McKee with his total hip replacement system. Reproduced by permission of ©Eastern Evening News. The photograph appeared in a Derek James column, ‘Honour for most deserving doctor’, 28 November 2003. 9 Figure 7 Post-operative X-ray of the McKee artificial joint, 1963. Illustration provided by the John Charnley Trust. 10 Figure 8 Hawley orthopaedic table showing a non-sterile assistant controlling the leg. Illustration provided by Mr John Kirkup. 11 Figure 9 Professor Sir John Charnley FRCS FRS. Reproduced by permission of Lady Charnley. 12 Figure 10 Mr Harry Craven, 1981. Illustration provided by Mr Harry Craven. 13 Figure 11 Stainless steel Smith-Petersen cup (4.5cm diameter x 4 cm), c. 1938. Donated by Mr Victor Wheble. 14 v Figure 12 Charnley’s original greenhouse clean air enclosure, 1960. Illustration provided by the John Charnley Trust. 15 Figure 13 Filters and masks. From The Times (30 November 1965): 20. Illustration provided and annotated by Mr John Read. 17 Figure 14 Looking down on to the greenhouse roof showing three cloth infuser bags inflated with clean air. Illustration provided by Mr Harry Craven. 18 Figure 15 The Charnley low-friction arthroplasty in use from November 1962. Illustration provided by the John Charnley Trust. 18 Figure 16 Mr ‘Ginger’ Wilson, 2000. Illustration provided by Mr Michael Wilson. 20 Figure 17 Principal stages in the design and development of the Stanmore prosthesis, 1960–85. Illustration provided by Mrs Phyllis Hampson. 21 Figure 18 ICLH resurfacing arthroplasty done bilaterally, c. 1980. Illustration provided by Professor Michael Freeman. 23 Figure 19 Professor John Scales, designer of the Stanmore hip, c. 1985. Reproduced by permission of Mrs Phyllis Hampson. 31 Figure 20 The Exeter stem, c. 1969. Reproduced by permission of Professor Robin Ling. 32 Figure 21 Still’s disease – juvenile chronic arthritis. Reproduced by permission of the Wellcome Photo Library. 34 Figure 22 A Charnley acetabular reamer. Illustration provided by the John Charnley Trust. 39 vi Figure 23 Surgical approaches used in total hip replacement. Anterolateral incision; direct lateral incision; lateral incision and the modern minimally invasive incision. Drawn by Mr Kevin Hardinge. 46 Figure 24 Howorth publicity literature, c. 1976. Illustration provided by the John Charnley Trust. 75 Figure 25 Casella slit sampler AIR14 as used in the 1960 clean air enclosure. Illustration provided by Howorth Airtech Ltd. 78 Figure 26 Two Petri dishes from a slit sampler with a rotation time of 60 minutes, c. 1960. Illustration provided by Mr Harry Craven. 79 Table 1 Survival rates of Charnley, Stanmore and Exeter THR. Extracted from Malchau et al. (2002): 9, Table 1. 75 vii Appendix 3: Selected prosthetic hips 1938 Wiles Illustration provided by Sir Rodney Sweetnam. 101 1938 Smith-Petersen Reproduced by permission of the Wellcome Trust. 101 1940 Judet Reproduced by permission of the Wellcome Trust. 101 1951 Moore Illustration provided by the John Charnley Trust. 102 1953 Thompson Illustration provided by the John Charnley Trust. 102 1956– McKee Illustrations provided by the John Charnley Trust. 102 1956– Charnley (a–c) the John Charnley Research Institute, Wrightington Hospital; (d) the John Charnley Trust. 103 1963– Stanmore (a) Mr Michael Wilson; (b–c) Mr Alan Lettin; (d) Wellcome Trust. 104 1968– Ring Illustration provided by Mr Peter Ring. 105 1970– Exeter Illustrations provided by the Exeter Hip Unit. 105 1972– ICLH Illustration provided by Professor Michael Freeman. 106 1991– McMinn Illustration provided by Mr Joseph Daniel, McMinn Centre. 106 viii Abbreviations BOA British Orthopaedic Association BOSG British Orthopaedic Study Group BSI British Standards Institution CEN Comité Européen de Normalisation, the European Committee for Standardization, Brussels, Belgium at www.cenorm.be DoH Department of Health FDA US Food and Drug Administration HAC hydroxyapatite coating HDP high-density polyethylene ISO Interational Organization for Standardization, Genève, Switzerland at www.iso.org/isoenCatalogueListPage. CatalogueList LFA low-friction arthroplasty MCA Medicines Control Agency MDA Medical Devices Agency MHRA Medicines and Healthcare Products Regulatory Agency MRC Medical Research Council NHS National Health Service NICE National Institute for Clinical Excellence NJR National Joint Registry for England and Wales PMMA polymethylmethacrylate PTFE polytetrafluoroethylene RNOH Royal National Orthopaedic Hospital, Stanmore, Middlesex at www.rnoh.nhs.uk/about_the_RNOH/ ix THA total hip arthroplasty THR total hip replacement UHMWPE ultra-high molecular weight polyethylene UMIST University of Manchester Institute of Technology, which merged with the Victoria University of Manchester to become the University of Manchester in 2004. x WITNESS SEMINARS: MEETINGS AND PUBLICATIONS 1 In 1990 the Wellcome Trust created a History of Twentieth Century Medicine Group, associated with the Academic Unit of the Wellcome Institute for the History of Medicine, to bring together clinicians, scientists, historians and others interested in contemporary medical history. Among a number of other initiatives the format of Witness Seminars, used by the Institute of Contemporary British History to address issues of recent political history, was adopted, to promote interaction between these different groups, to emphasize the potential benefits of working jointly, and to encourage the creation and deposit of archival sources for present and future use. In June 1999 the Governors of the Wellcome Trust decided that it would be appropriate for the Academic Unit to enjoy a more formal academic affiliation and turned the Unit into the Wellcome Trust Centre for the History of Medicine at UCL from 1 October 2000. The Wellcome Trust continues to fund the Witness Seminar programme via its support for the Centre. The Witness Seminar is a particularly specialized form of oral history, where several people associated with a particular set of circumstances or events are invited to come together to discuss, debate, and agree or disagree about their memories. To date, the History of Twentieth Century Medicine Group has held 45 such meetings, most of which have been published, as listed on pages xv–xxiii. Subjects are usually proposed by, or through, members of the Programme Committee of the Group, which includes professional historians of medicine, practicing scientists and clinicians, and once an appropriate topic has been agreed, suitable participants are identified and invited. This inevitably leads to further contacts, and more suggestions of people to invite. As the organization of the meeting progresses, a flexible outline plan for the meeting is devised, usually with assistance from the meeting’s chairman, and some participants are invited to ‘set the ball rolling’ on particular themes, by speaking for a short period to initiate and stimulate further discussion. 1 The following text also appears in the ‘Introduction’ to recent volumes of Wellcome Witnesses to Twentieth Century Medicine published by the Wellcome Trust and the Wellcome Trust Centre for the History of Medicine at UCL. xi Each meeting is fully recorded, the tapes are transcribed and the unedited transcript is immediately sent to every participant. Each is asked to check his or her own contributions and to provide brief biographical details. The editors turn the transcript into readable text, and participants’ minor corrections and comments are incorporated into that text, while biographical and bibliographical details are added as footnotes, as are more substantial comments and additional material provided by participants. The final scripts are then sent to every contributor, accompanied by