John Charnley
John Charnley | |
---|---|
Born | 29 August 1911 Bury,Lancashire,England |
Died | 5 August 1982 Manchester,England | (aged 70)
Nationality | British |
Alma mater | Victoria University of Manchester |
Known for | Hip replacement[2][3] |
Awards | Gairdner Foundation International Award(1973) Lasker-DeBakey Clinical Medical Research Award(1974) Cameron Prize for Therapeutics of the University of Edinburgh(1974) Lister Medal(1975) Albert Medal(1978) Fellow of the Royal Society[1] |
Scientific career | |
Fields | Orthopaedic surgeon |
Sir John Charnley,CBE,FRS[1](29 August 1911 – 5 August 1982) was an Englishorthopaedic surgeon.He pioneered thehip replacementoperation,[4]which is now one of the most common operations both in the UK and elsewhere in the world, and created the "Wrightington centre for hip surgery". He also demonstrated the fundamental importance of bony compression in operations toarthrodese(fuse) joints, in particular the knee, ankle and shoulder.[5][6][7][8]
Charnley also influenced generations of orthopaedic surgeons through his textbook on conservative fracture treatment[9]which was first published in 1950.
Early life
[edit]John Charnley was born inBury,inLancashire,on 29 August 1911.[10]
His father, Arthur Walker Charnley, was a chemist and had a chemist's shop at 25 Princess Street; his mother, Lily, had trained as a nurse atCrumpsall Hospital.He also had a younger sister, Mary Clare.
John went to theBury Grammar Junior Schoolin 1919, moving on to theSenior schoolin 1922. He had a scientific aptitude and was encouraged to study chemistry and physics.[11]
In the autumn of 1929 he gained admission to theMedical Schoolof theVictoria University of Manchester,from where he graduated with aBachelor of Medicine,Bachelor of SurgeryandBachelor of Science(Anatomy and Physiology) in 1935.[12]
First surgery and war service
[edit]From 15 August 1935, Charnley was appointed aHouse Surgeonat the Central Branch ofManchester Royal Infirmaryin Roby Street, and after three months he went to the main Infirmary where he completed his year as House Surgeon.[13]
![](https://upload.wikimedia.org/wikipedia/commons/thumb/e/e0/Manchester_Royal_Infirmary%2C_1957.jpg/220px-Manchester_Royal_Infirmary%2C_1957.jpg)
As his friendDavid Lloyd Griffithsremembers, Charnley considered the possibility of becoming involved withcancerresearch, but most of his professors thought it was a waste of time and dissuaded him.[14]He planned to achieve the status ofFellow of the Royal College of Surgeonsas soon as possible and, after having attended the fellowship course atGuy's HospitalinLondon,he passed the final examination on 10 December 1936.
He obtained the post ofResident Surgical OfficeratSalford Royal Hospitalon 1 January 1937, and after 21 months he unsuccessfully applied for the similar post at Manchester Royal Infirmary.[15]He then realised the career opportunities presented by research work and was appointed as ademonstratorin physiology atKing's College Londonin October 1938.
The opportunity to return to Manchester came when he was appointed aResident Casualty Officer(RCO) in April 1939. This work put him in contact with many orthopaedic specialists, since he was responsible for cases presenting at the daily morning fracture clinics. During the afternoons and nights, he acted as the Resident Surgical Officer, operating on general emergencies.
By the end of 1939, Charnley's projects[clarification needed]had been stymied by the outbreak ofWorld War II.He joined the troops as a volunteer in theRoyal Army Medical Corpson 1 May 1940 and, after a training period, he was posted toDoveras a Regimental Medical Officer. He participated in the Britishevacuation of Dunkirkand, subsequently, he was sent to 31st General Hospital atHellingly,East Sussex.He then moved toDavyhulme Park Hospitaland later to the General Hospital atGarrioch.[16]
Finally, he was sent toCairo;there he spent most of his military service under the supervision of orthopaedic surgeonDudley Buxton.Buxton had a high opinion of Charnley and gave him more responsibilities by sending him to the 2nd Orthopaedic Centre and putting him in charge of the new orthopaedic workshop. That experience probably encouraged him to apply for the orthopaedic school in 1942, with the support of his senior colleagues. He was promoted to the rank ofActing Majoron 2 December 1942.[citation needed]
He ended his military service in May 1944, when he joined the orthopaedics staff atShaftesburyHospital.[17]
Back to Manchester
[edit]The end of the war was also the beginning of a national scheme for the cure of crippled children, which involved the use of open-air rural orthopaedic hospitals. One of these was theRobert Jones and Agnes Hunt Orthopaedic HospitalatGobowen,nearOswestryinShropshire,andHarry Plattrecommended that Charnley went there in order to improve his skills as an orthopaedic surgeon. He was resident in the hospital for six months in 1946, during which he developed his interest inbone grafting.In order to satisfy his curiosity about bony union, he persuaded a junior colleague to test a surgical procedure on his leg, which resulted in a wound infection that forced the colleague to bed for some weeks.[18]Thereafter, Charnley returned to Manchester, again with the support of Platt, who had brought to the Royal Infirmary a group of young and brilliant orthopaedic specialists, which included Lloyd Griffiths. Charnley and Griffiths became joint honorary assistant orthopaedic surgeons in 1947. They both needed more clinical independence, and Platt arranged that Charnley saw some more clinical patients in other hospitals.[19]
In May 1948, he participated in a work trip to the United States, visiting hospitals there, together with other young orthopaedic surgeons. The experience caused him to consider the possibility of basing himself in the USA, but that country's restrictions on experimental surgeries were unacceptable to him.[20]
He was interested in two basic orthopaedic problems: the effect of compression on the healing ofcancellous bone,and the lubrication of joints.[21]He was convinced that collaborations with mechanical engineers, with whom he developed strong relationships, were fundamental to expanding his knowledge and improving his work.
Charnley's research was based on two different aspects: clinical, for the treatment of patients with osteoarthritis, andbiomechanical,with experiments to determine the fundamentals of bony union and the conditions governing the spontaneous regeneration of articular cartilage.[22]
When he returned to Manchester after the war, the facilities available did not live up to his expectations. From then on, he began to think of reducing the number of clinical sessions he was undertaking, in order to carry out his research elsewhere. He finally opted for this path in 1958, informing the Manchester Royal Infirmary surgeons' committee that he wished to hand over three of his four clinical sessions in order to set up a hip surgery centre atWrightington Hospital,Lancashire.[23]The committee agreed to his request for a period of three years, after taking into account his skills and reputation. The decision was to be reviewed at the end of that period.[24]
Wrightington and hip implant
[edit]![](https://upload.wikimedia.org/wikipedia/commons/thumb/2/2f/Hip_replacement_Image_3684-PH.jpg/220px-Hip_replacement_Image_3684-PH.jpg)
Wrightington had formerly been a centre for the treatment oftuberculosis.Improved living conditions and pasteurisation of milk had caused a decline in the incidence of that illness and many hospitals were seeking new medical endeavors upon which to focus. In the case of Wrightington, it was Charnley's hip surgery centre that came to the fore.[25]
Charnley's first aim at Wrightington was to build a biomechanical laboratory that could be used to test his instruments and inventions. He organised a fund raising campaign for this purpose and the laboratory opened on 23 June 1961.[26] His first studies concerned lubrication of joints. At that time, some surgeons were supporting the hydrodynamic theory, which assumed that the two faces of a joint are not perfectly congruous, and that a film ofsynovial fluidis responsible for the low friction of the surfaces. Charnley disagreed with that theory; through his experiments, he was able to demonstrate that the low friction does not depend on the fluid presence. The studies led to the development of the Low Friction Arthroplasty concept, which assumed that the low friction depended mostly on thefriction coefficientof the facing materials, and only marginally on the fluid presence.[27]
This discovery caused him to begin looking for a slippery substance that could be used for the socket of a total hip replacement operation.Polytetrafluorethylene(PTFE, also known as Teflon) seemed to meet this requirement. After some apparently successful experiments with the material, he adopted it for his hip replacement surgeries. They were carried out as follows: discarding the head of thefemur;replacing it with a metallic implant that was fixed with acrylic cement; and, using a PTFE acetabular socket, insertion of the implant into theacetabulum.[28]
At first, the result seemed to be satisfactory, however, approximately one year after the first operations (about 1960), it became clear that PTFE was not a suitable material. It showed signs of wear and, most importantly, its reaction with soft tissues caused the formation of granulomatous masses that in almost all cases required a further operation to enable their removal. This setback in Charnley's research affected him for some time.[29]
His determination pushed him to seek an alternate material. He continued to test various materials, until a salesman approached him offeringUltra-high-molecular-weight polyethylene(UHMWPE), which he rejected because of his lack of understanding of the problem; his assistant told him privately that he would endeavor to test it.[30]It was serendipity, and he immediately grasped the potential of the HMWP; after some tests, Charnley implanted it for the first time in November 1962.[31]Mindful of his previous failure with the PTFE socket, he waited for a year, during which time he carefully observed the status of his patients. Five years later, when he was convinced that HMWP was a safe material, he announced his discovery, making it possible for other surgeons to use it.[32]As time went by, the number of operations increased, and Charnley designed a machine which mechanically built prostheses and sockets,as well as an apparatus for evaluating patients for their hip disorders before and after the operation.[33]
![](https://upload.wikimedia.org/wikipedia/commons/thumb/2/22/Lathe_used_by_Sir_John_Charnley_to_make_cups_for_hip_replacements.jpg/220px-Lathe_used_by_Sir_John_Charnley_to_make_cups_for_hip_replacements.jpg)
He collaborated very closely with the firm ofChas. F. Thackray Ltdin Leeds, whom he had first asked to make instruments for him in 1947. Charnley refined his hip replacement operation throughout his long association with Thackray's and was still working on improvements when he died. At first Thackray's made the stainless steel stems, while Charnley made the sockets himself, turning them on a lathe in his workshop at home. Later his technicians made instruments under close supervision and then Thackray's manufactured them. As time went on, Thackray's contributed their own design suggestions; this continual exchange of ideas was a significant factor in the advance of the hip operation.[35]
Charnley was convinced that the best way to fix the prosthesis into the femur was to usebone cementthat acted as agroutrather than as a glue and that interlocked the two parts.[36]He believed that the cement had to have some essential features:
- It had to be prepared without unnecessary additives;
- The exact constituents should be published;
- It had to be sterilised with formaldehyde;
- The package should include two measured quantities ofbarium sulphateto allow the surgeon the choice of different degrees of radio-opacity.[37]
The cement that reflected these features was produced by CMW Laboratories Limited and was called CMW bone cement.[38]
Charnley also realised that it was of fundamental importance to retrieve the artificial joints from patients who had died some years after the surgery, in order to study the wear of the materials and the tissue changes, thus enabling improvements in the procedure.[39]
Against infection
[edit]![](https://upload.wikimedia.org/wikipedia/commons/thumb/4/47/Ventilated_surgical_exhaust_suit_designed_by_Sir_John_Charnley.jpg/220px-Ventilated_surgical_exhaust_suit_designed_by_Sir_John_Charnley.jpg)
The huge number of wound infection cases after hip replacement operations pushed Charnley to put effort also in the prevention field; he was involved in the research of a method to keepbacteriaaway from the wound during surgery. His first attempt consisted in introducingantibioticssuch as gentamicin into the bone cement; the bacterial count decreased, but not enough.[41]In 1961 he developed an enclosure that isolated the operating theatre from the rest of the room, into which filtered air could be passed. To improve his system, he askedF. H. Howorth,whose family firm had been building air filtration systems since 1854, for help. Howorth adapted Charnley's enclosure to provide better air handling and incorporate a diffusion system that allowed the passage of a larger flow of filtered air.[42]Charnley understood that another source of contamination was through the surgeon's gown, and he developed a full-body gown that incorporated an exhaust system. This came into use from the 1970s, and was ventilated so that the surgeon always felt comfortable, whilst maintaining a negative pressure to avoid contamination.[43]
Both the enclosure and the body gown were redesigned and improved over time in order to make them more useful and easier to use.[44]
Personal life
[edit]Although not inclined to sporting pastimes as a child, Charnley became a passionate skier as an adult. In 1957, during his annual skiing holiday inZurs,he met Jill Heaver (1930–2016). Despite a twenty-year difference in ages - she was 26 and he was 46 - they married a few months later, on 15 June.[45]They lived first in a house called "Naemoor" inHale,inCheshire,where Charnley immediately converted the attic in his workshop.[46]The couple had two children.[47]In the late 1960s, the Charnleys moved to a larger property inMere, Cheshire.[48]
Career
[edit]John Charnley is recognised as the founder of modern hip replacement. His contributions to the field are found in the hip replacement surgery method, in the optimization of the surgery flows and in the drastic infection rate decrease. Through his teaching activities, he transmitted his technique and knowledge to a wide audience of international surgeons and thus his academic and scientific work was spread worldwide.[49]As of 2011, many of his students were still teaching hip replacement.
In 1974, Charnley was awarded theCameron Prize for Therapeutics of the University of Edinburgh.
He was awarded the 1975Lister Medalfor his contributions to surgical science.[50]The corresponding Lister Oration, given at the Royal College of Surgeons of England, was delivered on 26 May 1976, and was titled 'The Origins of Post-Operative Sepsis in Elective Surgery'.[51]
Charnley wasknightedin 1977.
Books
[edit]- Charnley, John (1950).The Closed Treatment of Common Fractures.Churchill Livingstone, Edinburgh and London.
- Charnley, John (1953).Compression Arthrodesis.Churchill Livingstone, Edinburgh and London.
References
[edit]- ^abNisbet, N. W.;Woodruff, M.(1984). "John Charnley. 29 August 1911 – 5 August 1982".Biographical Memoirs of Fellows of the Royal Society.30:117–137.doi:10.1098/rsbm.1984.0004.JSTOR769822.PMID11616002.S2CID42716782.
- ^Jackson, J. (2012). "Father of the modern hip replacement: Professor Sir John Charnley (1911-82)".Journal of Medical Biography.19(4): 151–156.doi:10.1258/jmb.2011.011021.PMID22319187.S2CID207200585.
- ^Bigliani, L. U.; Cofield, R. H.; Flatow, E. L.; Fukuda, H. A.; Hawkins, R. J.; Matsen Fa, F. A.; Morrison, D. S.; Rockwood Jr, C. A.; Warren, R. F. (2009). "Charles Neer: On the giant of the shoulder".Journal of Shoulder and Elbow Surgery.18(3): 333–338.doi:10.1016/j.jse.2009.01.033.PMID19393927.
- ^Wroblewski, B. M. (2002)."Professor Sir John Charnley (1911-1982)".Rheumatology.41(7): 824–825.doi:10.1093/rheumatology/41.7.824.PMID12096235.
- ^Brand, R. A. (2010)."Biographical Sketch: Sir John Charnley MD, 1911–1982".Clinical Orthopaedics and Related Research.468(12): 3147–3148.doi:10.1007/s11999-010-1547-6.PMC2974887.PMID20852975.
- ^Donald, S. M. (2007). "Sir John Charnley (1911-1982): Inspiration to future generations of orthopaedic surgeons".Scottish Medical Journal.52(2): 43–46.doi:10.1258/rsmsmj.52.2.43.PMID17536642.S2CID23252729.
- ^Lidwell, O. M. (1993). "Sir John Charnley, surgeon (1911-82): The control of infection after total joint replacement".The Journal of Hospital Infection.23(1): 5–15.doi:10.1016/0195-6701(93)90125-j.PMID8095948.
- ^Eftekhar, N. S. (1983). "In memory of Sir John Charnley. August 29, 1911-August 5, 1982".The Hip:1–6.PMID6368477.
- ^The closed treatment of common fractures. John Charnley. Churchill Livingstone. Third edition. Edinburgh and London 1974.ISBN0-443-00119-7
- ^Waugh 1990,p. 1.
- ^Waugh 1990,p. 4.
- ^Waugh 1990,p. 9.
- ^Waugh 1990,p. 14.
- ^Waugh 1990,p. 15.
- ^Waugh 1990,p. 16.
- ^Waugh 1990,p. 21-23.
- ^Waugh 1990,p. 24-31.
- ^Waugh 1990,p. 33-34.
- ^Waugh 1990,p. 36.
- ^Waugh 1990,p. 38-39.
- ^Waugh 1990,p. 48.
- ^Waugh 1990,p. 83.
- ^Waugh 1990,p. 84.
- ^Waugh 1990,p. 85.
- ^Waugh 1990,p. 114-115.
- ^Waugh 1990,p. 116-117.
- ^Waugh 1990,p. 102-104.
- ^Waugh 1990,p. 105-108.
- ^Waugh 1990,p. 120-121.
- ^"AAOS 75th - Stories - Physician Story".Archived fromthe originalon 19 April 2015.Retrieved28 February2016.
- ^Waugh 1990,p. 122-124.
- ^Waugh 1990,p. 128-129.
- ^Waugh 1990,p. 126-128.
- ^"600604 | Collections Online".collections.thackraymuseum.co.uk.Retrieved28 August2024.
- ^Penny, Wainwright (1993)."Chas. F. Thackray Ltd: suppliers to the surgeons".Socialist Health Association.Retrieved11 April2014.
- ^Waugh 1990,p. 141.
- ^Waugh 1990,p. 143-144.
- ^Waugh 1990,p. 143.
- ^Waugh 1990,p. 142.
- ^"798.001 | Collections Online".collections.thackraymuseum.co.uk.Retrieved28 August2024.
- ^Waugh 1990,p. 150.
- ^Waugh 1990,p. 154-157.
- ^Waugh 1990,p. 160-161.
- ^Waugh 1990,p. 162.
- ^Waugh 1990,p. 87-88.
- ^Waugh 1990,p. 89-90.
- ^Waugh 1990,p. 91.
- ^Waugh 1990,p. 92.
- ^Waugh 1990,p. 185-196.
- ^Lister Medal,Ann R Coll Surg Engl. 1975 June; 56(6): 339-340.
- ^"College Diary"(PDF).Ann R Coll Surg Engl.58(3): 252. May 1976.
Bibliography
[edit]- Waugh, William (1990).John Charnley: The Man and the Hip.Springer-Verlag London Limited.ISBN978-3-540-19587-0.
- Barker, Philip (2002).Top 1000 Scientists: From The Beginning Of Time To 2000 Ad.Book Guild Publishing.ISBN978-81-7371-210-4.
Further reading
[edit]- Reynolds, L. A.; Tansey, E. M. (eds.).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(PDF).[permanent dead link]
- Gomez, Pablo F.; Morcuende, Jose A. (2005)."A Historical and Economic Perspective on Sir John Charnley, Chas F. Thackray Limited, and the Early Arthroplasty Industry".The Iowa Orthpaedic Journal.25:30–37.PMC1888784.PMID16089068.
External links
[edit]- 1911 births
- 1982 deaths
- 20th-century English medical doctors
- People educated at Bury Grammar School
- British orthopaedic surgeons
- Alumni of the Victoria University of Manchester
- People from Bury, Greater Manchester
- Fellows of the Royal Society
- Fellows of the Royal College of Surgeons of England
- Knights Bachelor
- Commanders of the Order of the British Empire
- Recipients of the Lasker–DeBakey Clinical Medical Research Award
- 20th-century surgeons
- British Army personnel of World War II
- Royal Army Medical Corps officers