Professor Sir John Charnley

Name:                        Professor Sir John Charnley DSc FRCS FRS – 1911 to 1982

Achievements:         Pioneer of the total hip replacement operation
                                  Visiting Surgeon Park Hospital Davyhulme

John Charnley was born in Bury on 29th August 1911. His father had a chemist’s shop and his mother was a nurse at Crumpsall Hospital. He attended Bury Grammar School, where initially he did not shine academically. Small for his age and averse to sport he did not stand out until his later years at the school, when his natural aptitude for science became apparent. The headmaster wisely persuaded him to do medicine, rather than dentistry; his father practiced simple dental extractions at his chemist’s shop and hence his initial choice.

In 1929 he entered medical school at Manchester University. During the course he was awarded BSc degrees in anatomy and physiology and qualified MB ChB in 1935. A year later he became a Fellow of the Royal College of Surgeons, at the youngest age possible. He then worked as a resident at Salford Royal Infirmary, King’s College London, and Manchester Royal Infirmary. At that time, Manchester was a mecca for the relatively new speciality of orthopaedic surgery, attracting several bright young surgeons under the guidance of Professor Sir Harry Platt.

ua-charnley-01-docIn May 1940, he volunteered for military service and was present at the evacuation from Dunkirk. After a period in Northern Ireland he was posted on 7th August 1940 to Park Hospital, Davyhulme (this birthplace of the NHS was later renamed Trafford General, for no good reason) which had become a military hospital, the civilians being treated at Abbotsfield, now Flixton Conservative Club. His interest in orthopaedic surgery was rekindled and Harry Platt came to Park Hospital every Thursday morning to oversee his work and give guidance. After about six months he was posted to Egypt, where he gained much surgical experience. In November 1943 Park Hospital was transferred to the US Army as the 10th US Station Hospital, and remained so until July 1945.

After the war, he returned to Manchester and obtained a relatively small commitment at Manchester Royal Infirmary. In 1947 he was appointed Visiting Orthopaedic Surgeon at Park Hospital and continued in this position until 1962. In 1949 he was also given a similar position at Wrightington Hospital.

Charnley had a brilliantly sharp mind, with the ability to dissect a problem into all its constituent parts and then to set about solving them one by one. His initial interests were in the principles of non-operative treatment of fractures and in joint arthrodesis (fusion) by compression. His books on these subjects were compulsory reading for aspiring surgeons. Although not an engineer by training, he had an intuitive and practical grasp of the subject, designing many instruments and appliances. Whilst very kind and caring to patients with significant physical problems, he had no time for hypochondriacs and many apocryphal tales from Park Hospital outpatients bear witness to this aspect of his personality.

 

Hip osteoarthritis is a common condition and causes a considerable amount of pain and disability for which, up to 1960s, there was no very effective treatment. John Charnley focussed his considerable intellect and energy on this problem and its solution. He knew that a hip replacement operation would be necessary but there were many problems to overcome. What materials could be used to give a low friction joint? Would these materials be tolerated and not rejected by the body? Would these materials have good wear characteristics and last for many years? How would they be fixed to bone? Implanted foreign material gives rise to a significant risk of persistent infection; how could this be minimised to an acceptably low level?

ua-charnley-02In a brilliant period of investigations, he gradually solved these problems one by one, some with experiments upon himself. A stainless-steel ball and stem with a socket of high density polyethylene had the necessary properties of being inert and possessing the required wear characteristics. A smaller than normal ball and socket gave low frictional characteristics. The components were grouted to bone using acrylic cement which gave sound fixation. Infection was minimised by using special operating theatres with filtered positive pressure air flow, and the surgeons wearing special clothing and helmets with air extraction.

At last there was an effective hip replacement operation. Sadly, for Park Hospital, John Charnley moved full-time to Wrightington Hospital in 1962 as they had given him the necessary facilities for research: as a result, Wrightington Hospital became a world-famous centre for hip surgery, with surgeons coming from all over the world to learn the techniques.

He was knighted for his work in 1977. His operation remains the gold standard in total hip replacement, although now there are many variations. An estimated 2.5 million Americans are living with total hip replacement prostheses and in the UK about 80,000 of these operations are performed every year. Joint replacement surgery has been remarkably successful in improving the quality of life of those with an arthritic hip. This was his great legacy.

 

 By:      Rob Davies BSc MB ChB MD FRCS – December 2016

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