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Bfm:978-1-4471-3159-5/1.Pdf John Charnley, 1911-1982 JOHN CHARNLEY The Man and the Hip William Waugh Springer-Verlag London Berlin Heidelberg New York Paris Tokyo Hong Kong William Waugh, MChir, FRCS Emeritus Professor of Orthopaedic and Accident Surgery, University of Nottingham, and Emeritus Consultant Orthopaedic Surgeon, Harlow Wood Orthopaedic Hospital, near Mansfield, UK 2 Mill Lane, Wadenhoe, Nr Oundle, Peterborough PES SST, UK ISBN-13:978-1-4471-3161-8 e-ISBN-13:978-1-4471-3159-5 DOl: 10.1007/978-1-4471-3159-5 British Library Cataloguing in Publication Data Waugh, W. John Charnley. 1. England. Medicine. Orthapaedics. Charnley. John 1. Tide 617' .3'00924 ISBN-13:978-1-4471-3161-8 Library of Congress Cataloging-in-Publication Data Waugh, W. (William), 1945- John Charnley: the man and the hip/by William Waugh. p. cm. Includes bibliographical references. 1. Charnley, John. 2. Orthopedists-Great Britain-Biography. 3. Artificial hip joints-Great Britain-History. 1. Tide. [DNLM: 1. Surgery-biography. WZ 100 C4827W] RD728.C48W38 1990 617.5'81059'092-dc20 [B] DNLMlDLC for Library of Congress 89-21895 CIP Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act, 1988, this publication may only be reproduced, stored or transmitted, in any form or by any means, with the prior permission in writing of the publishers, or in the case of reprographic reproduction in accordance with the terms of licences issued by the Copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to the publishers. © Springer-Verlag London Limited 1990 Softcover reprint of the hardcover 1st edition 1990 The use of registered names, trademarks etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore free for general use. Filmset by Photo·graphics, Honiton, Devon 2128/3916-543210 Printed on acid-free paper PREFACE Hip replacement operations have become commonplace during the past ten years, but none the less it is well to remember the struggle to overcome the initial difficulties before the achievement of the successful results which are confidently expected today. Certainly, in the 1950s attempts to relieve pain and restore movement to an arthritic hip frequently failed. Such operations which were practised often involved a prolonged period of immobilisation which would now not be tolerated. For progress to be made orthopaedic surgeons had to rely on the loyalty and stoicism of their patients who allowed untried procedures to be carried out on themselves, often without appreciating the possible outcome. These surgical experiments resulted in progress being made, and the failures led to a greater understanding of the problems involved. The importance of collaboration with bio-engineers was also recognised, and the search began for suitable materials with which to make an artificial joint. Progress was made in many centres throughout the world, and surgeons in the United Kingdom were at the forefront in devising original techniques. Although others also produced new models, John Charnley was a pioneer and an innovator who influenced the development of hip relacement more than any other individual. In telling the story of his life this book is inevitably also the story of the operation, but it is not intended to be a scientific evaluation of his work. A biography of this nature is difficult to write chronologically, although I have written the first part in this way. The second part is approached differently in that various topics are taken separately, but the emphasis remains with biography rather than surgery. At this stage, I should declare my own interest. In 1956, when I was working at what was then the Wingfield-Morris Orthopaedic Hospital (now the Nuffield Orthopaedic Centre) in Oxford, I wrote to ask Charnley if I could visit him in Manchester to learn about the operation for stabilisation of the hip joint which he had devised at that time. He took me out to dinner and I well remember going with him to his laboratory at the Medical School later that evening. There he had an ankle joint swinging in a pendulum apparatus which was part of his v vi Preface investigation into the lubrication of joints and which led to his original concept of his low friction arthroplasty. The next day he demonstrated the stabilisation operation; this was an arthrodesis to stiffen the hip, rather than an arthroplasty to restore movement. Back at Oxford, Professor Trueta, whose assistant I was, allowed me to follow Charnley's technique. I had some difficulty (I cannot now remember precisely what) so I wrote to ask his advice. What I do remember is that I received, within a day or two, a long handwritten letter (with diagrams) which explained precisely what to do. Unfortunately, this correspondence is lost, but the impression created endured; it seemed remarkable that he was prepared to go to so much trouble to ensure that a junior colleague should understand exactly what he thought should be done. From then on, I followed his work with great interest and we often talked at orthopaedic meetings. It was not, however, until March 1969 that I visited the Centre of Hip Surgery at Wrightington Hospital with two of my colleagues from Harlow Wood Orthopaedic Hospital. We saw the new operation, as well as visiting the wards and a clinic; and, most important, the biomechanicallaboratory. We were 'approved' and our hospital was allowed to purchase the prostheses. The operation at first seemed complicated, but we knew that it had to be carried out correctly and we persevered with his instructions. Those familiar with hip replacement today may find it difficult to appreciate how exciting an innovation this was. When we had trouble with infection, Charnley was sympathetic and helpful. At a visit to discuss the problem in 1971 I remember his school-boyish delight at wearing his 'space suit' for the first time. His enthusiasm was encouraging, and his attention to detail and his single-minded dedication were impressive. I remained convinced that Charnley's arthroplasty was the best, both in materials and method, and every assistant who worked with me during the next fifteen years always visited Wrightington to learn the technique at first hand. Two coincidental personal connections interested me as I began work on the book. First, I found that Charnley's research in London was done with my father-in-law, Professor R.J.S. McDowall who was professor of physiology at King's College, London. Second, my teacher in orthopaedics at King's College Hospital, Mr St.J.D. Buxton, had left his war diaries to the Royal College of Surgeons in London: these made it clear that Buxton, who was then consultant orthopaedic surgeon to the Middle East Forces, had picked out Charnley to be in charge of a newly formed appliance workshop in Cairo in 1941: It is acknowledged that Sir Harry Platt played a critical part in Charnley's orthopae.dic career, but there is no doubt that Buxton recognised his ability very early on and ensured that he had facilities to pursue his mechanical and engineering interests. Towards the end of his life Charnley kept a record of his thoughts and activities, but his journal petered out after three months under pressure of other work which he must have considered to be of greater importance. However, he left a large number of published papers in orthopaedic and other journals, and at times these reveal glimpses of his personal opinions. I have quoted from his writing frequently; not to advance his scientific views, but rather to give an insight into his character. The library of the Medical School in Nottingham went to endless trouble to find and produce all (except two) of his publications. A certain amount of personal correspondence was kept by his secretary and has provided a core of information illuminating events in his life which have not been previously recorded. Preface vii What is now fashionably called oral history has formed a most valuable source. His widow, Lady Charnley entered into the project with enthusiasm and without her help the biography would not have been possible. I cannot recall how many hours we spent discussing John, but she never failed to provide whatever help I needed. Her two children were equally willing to answer my questions, and a Sunday morning spent on the floor with a large box of unsorted family photographs produced a great deal of laughter and many of the illustrations for the book. For all this, I am very grateful. Another pleasure was tracking down (with Lady Charnley's help) and talking to John's surviving contemporaries and friends from his days as a medical student and young surgeon in Manchester and in the Army. They were all kind and hospitable, providing more photographs and answering more questions by letter. Some of them read the first draft of the early chapters and made constructive suggestions; in particular David Lloyd Griffiths and Norman Nisbet (not a contemporary, but co-author of the Royal Society's biographical memoir) acted as my 'intimate and judicious friends' as advocated by Dean Swift in his Letter to a Young Clergyman written in 1720. For the benefit of those unfamiliar with his advice, which applies equally well to writing as to lecturing, or giving sermons, the quotation is appended as a footnote*. Many, many other people helped as well; beginning with the man who taught John physics at Bury Grammar School and was aged 97 years when I talked to him, and continuing to the surgeons who are now working at Wrightington Hospital.
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