"The only type of operation that could ever be universal would be an arthroplasty."
John Charnley, lecture in 1959
More than 800,000 hip replacement operations are carried out globally every year. These enable their recipients to live more mobile and pain-free lives after their worn out, damaged, or diseased hip joints are replaced with artificial prostheses.
It was the pioneering work of English surgeon John Charnley (1911-1982) that led to low-friction arthroplasty becoming the gold-standard procedure for hip replacement. Charnley moved from a method of compression fixation of fractures to considering actually replacing the joint during his investigations into the. best way to treat osteoarthritis and other conditions limiting hip movement. In a lecture to the East Denbigh and Flint division of the British Medical Association in 1959, he said, "In orthopedics, surgeons yearn for an easy hip operation, or, if a good operation is difficult,...[that] it should be universally applicable."
Charnley met with opposition from colleagues but, working in Wrightington Hospital in Wigan, England, he persisted. His design included a steel femoral stem- and-ball section and a polyethylene hip socket, both attached to the bone with acrylic bone cement. He performed the first successful operation in 1962.
Charnley reduced infection in theater by using a clean-air enclosure, suits that covered the entire bodies of surgical staff, and an instrument-tray system. He also followed up on the effectiveness of each operation by persuading patients to bequeath their joints back to him so that he could examine each bone-cement interface and improve his technique.
Today hip replacement continues to evolve as people live longer and outlast the ten-year duration of their prostheses. Research into better materials will lead to more durable designs that should reduce the need for artificial hips to be replaced.
