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By the 18th century, scientific knowledge of skeletal structure was sufficiently advanced to allow the development of the precursors to the modern hip implant. Excision arthroplasty (removal of the affected parts of the joint, to be replaced by scar tissue) was well known, though not in widespread use due to the popularity of amputation, which was particularly common among sailors and soldiers. Prior to the invention of modern anesthetics, a premium was unsurprisingly placed on speed of the operation.
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The first successful reported excision hip arthroplasty was performed in 1821 by Anthony White, a surgeon at London’s Westminster Hospital. That was followed in 1826 by the first recorded hip osteotomy, performed in Philadelphia by John Rhea Barton. Barton’s patient was able to walk with a cane after the operation, but within 6 years had lost all mobility. Nonetheless, Barton’s procedure was significant for his recognition that gentle movement was required to help redevelop mobility after a procedure.
The development of general anesthetic and modern standards of surgical sterility in the 19th century paved the way for modern joint replacement.
The Berlin physician Themistocles Glück is widely credited with performing the first total joint replacement. In 1890 Glück successfully replaced a 17-year-old girl’s damaged knee with an ivory prosthesis. He also developed the first ball-and-socket hip replacement (also made of ivory, a material he had settled on after experimenting with alternatives such as aluminum, wood, and glass) and experimented widely with methods of adhering implants to existing bone. He designed artificial versions of most major joints in the human body, including the wrist and knee.
Glück’s work, however, was opposed by the scientific community and largely ignored during his lifetime. This was partially because all his implants, while successful in the short term, ultimately failed due to infection.
Early 20th Century
The first half of the 20th century saw widespread experimentation with partial hip replacement and resurfacing techniques, with varying levels of success. Prostheses were developed with materials such as ivory, rubber, glass, acrylic and Vitallium, an alloy of cobalt, chromium and other metals; methods of affixing the prosthetics to the hip bones were equally diverse, including screws and a variety of types of cement. One physician, Sir Robert Jones, used gold foil to cover a reconstructed femoral head.
Sir John Charnley
Partial hip replacements had been in use for three decades when British physician Sir John Charnley was presented with a patient whose acrylic plastic hip implant squeaked abominably every time he moved. Charnley’s efforts to solve the problem led him to invent a device (that he tested on himself) that utilized a metal femoral component and plastic acetabular cup. Charnley’s invention, unveiled in 1962, made modern hip replacement possible, revolutionizing the treatment of arthritis in the elderly. Modern artificial hips are based on his original design.
- Eynon-Lewis, N. J., Ferry, D., & Pearse, M. F. (1992). Themistocles Gluck: An unrecognised genius. BMJ, 305(6868), 1534-1536. doi:10.1136/bmj.305.6868.1534
- Gomez, P. F., & Morcuende, J. A. (2005). Early attempts at hip arthroplasty: 1700s to 1950s. The Iowa Orthopaedic Journal, 25, 25-29. PMCID:PMC1888777
- Science Museum. (n.d.). John charnley (1911-82). Retrieved from Brought to Life: Exploring the History of Medicine website December 31, 2013
- Invent Now. (n.d.). Inventor profile: John charnley. Retrieved from Invent Now Hall of Fame website January 8, 2014