John Charnley
He also demonstrated the fundamental importance of bony compression in operations to arthrodese (fuse) joints, in particular the knee, ankle and shoulder.
[13] As his friend David Lloyd Griffiths remembers, Charnley considered the possibility of becoming involved with cancer research, but most of his professors thought it was a waste of time and dissuaded him.
[14] He planned to achieve the status of Fellow of the Royal College of Surgeons as soon as possible and, after having attended the fellowship course at Guy's Hospital in London, he passed the final examination on 10 December 1936.
[15] He then realised the career opportunities presented by research work and was appointed as a demonstrator in physiology at King's College London in October 1938.
This work put him in contact with many orthopaedic specialists, since he was responsible for cases presenting at the daily morning fracture clinics.
[17] 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.
[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.
[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, and biomechanical, with experiments to determine the fundamentals of bony union and the conditions governing the spontaneous regeneration of articular cartilage.
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 at Wrightington Hospital, Lancashire.
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.
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 of synovial fluid is responsible for the low friction of the surfaces.
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.
[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.
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 use bone cement that acted as a grout rather than as a glue and that interlocked the two parts.
[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.
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.
[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'.
